2011 economic development...

CDBG Economic Development Application Guidelines

[July 1, 2015 Version]

Community Development Block Grant (CDBG)

Economic Development Program

Application Guidelines (Forms and Instructions)

State of Nebraska, Department of Economic Development

Housing and Community Development Division

Effective as of July 1, 2015

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http://www.neded.org/

http://www.neded.org/community/grants/applications/cdbg-forms



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Cover Page ............................................................................................................................................................. 1 Table of Contents .................................................................................................................................................. 2 Housing and Community Development Division Staff ...................................................................................... 3 General Requirements .......................................................................................................................................... 4

Eligible Applicants ............................................................................................................................................. 4 Eligible Businesses ........................................................................................................................................... 4 Eligible Activities and Forms of CDBG Assistance ........................................................................................... 5 Compliance with CDBG National Objective Requirements .............................................................................. 5 Maximum Amounts of Awards .......................................................................................................................... 5 Maximum Amount of CDBG Loan Forgiveness to a Benefited Business ......................................................... 6 Matching Requirements .................................................................................................................................... 6 Application Timing ............................................................................................................................................. 6 Federal Requirements—"Strings" ..................................................................................................................... 6 Other Considerations Affecting Project Eligibility .............................................................................................. 7 Program Income and Reuse Plans ................................................................................................................... 8

Overview of Process ........................................................................................................................................... 11 Underwriting & Decision-Making Criteria ......................................................................................................... 12 Program Specifics ............................................................................................................................................... 15

Compliance with CDBG National Objective Requirements ............................................................................ 16 SAM Registration ............................................................................................................................................ 18 DUNS Number ................................................................................................................................................ 18 Eligible Activities and Forms of CDBG Assistance ......................................................................................... 18 Special Conditions for Release of Funds ........................................................................................................ 21

Application Forms and Required Exhibits Checklist ....................................................................................... 23

Instructions for Parts I and II ........................................................................................................................... 24 Application Form (Part I) General Information ................................................................................................ 25 Application Form (Part II) Funding Summary .................................................................................................. 26 Exhibit A Participation Identification and Project Summary ........................................................................... 27 Exhibit B Project Financing and Use of Loan Proceeds ................................................................................ 29 Exhibit C Job Creation/Retention Information ................................................................................................ 30 Exhibit D Applicant's Statement of Assurances and Certifications ................................................................ 32 Exhibit E Citizen Participation Plan ................................................................................................................ 35 Exhibit F Notice of Public Hearing ................................................................................................................. 37 Exhibit G Resolution Authorizing Chief Elected Official to Sign ..................................................................... 38 Exhibit H FFATA Reporting Form/Certification .............................................................................................. 39 Exhibit J Program Income Certification ......................................................................................................... 40 Sample Employee Certification Form ............................................................................................................. 41



State of Nebraska, Department of Economic Development Housing and Community Development Division

301 Centennial Mall South, PO Box 94666, Lincoln, NE 68509-4666 http://www.neded.org/community

Department Phone: 402-471-3111 Toll-Free: 800-426-6505 Division Fax: 402-471-8405

Housing and Community Development (HCD) Division Staff:

Steve Charleston, HCD Division Director ........................................................................................ 402-471-3757

Community Development (CD) Team

Brian Gaskill, HCD Division Deputy Director & CDBG Program Manager ...................................... 402-471-2280

Heather Voorman, Community Development Coordinator ........................................................... 402-471-3775

Jenny B. Mason, Community Development Consultant ................................................................ 402-471-6280

Terry McAuliffe, Federal Aid Administrator ................................................................................... 402-471-3680

Rebecca Schademann, Economic Development Consultant .......................................................... 402-471-3172

Economic Development (ED) Team

Dave Honz, Economic Development Program Manager ................................................................ 402-471-3763

Tom Stephens, Economic Development Financial Packager .......................................................... 402-471-6587

Stew Jobes, NPLF Program Manager .............................................................................................. 402-471-3114

Anissa Rasmussen, Economic Development Financial Packager ................................................... 402-471-7999

Rose Baker, Economic Development Consultant/Job Training Coordinator .................................. 402-471-1559

Housing Team

Bob Doty, Housing Program Manager ............................................................................................ 402-471-2095

Bob Jones, Southeast Region Housing Representative .................................................................. 402-471-3742

Pamela Otto, Housing Development Consultant/Application Coordinator ................................... 402-471-4388

Rachel Meredith, Northeast Region Housing Representative ....................................................... 402-471-2843

Shannon Fortney, Central Region Housing Representative ........................................................... 402-890-4462

Kristi McClung, Western Region Housing Representative (Big Springs Office) ............................. 308- 889-3420

All email addresses are generally [email protected]. Please visit the department’s website at: http://www.neded.org/staff-directory for a current listing of all DED staff.

http://www.neded.org/community

mailto:[email protected]

http://www.neded.org/staff-directory



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The objective of the Nebraska Department of Economic Development ("Department" or "DED") for the Community Development Block Grant ("CDBG") Economic Development ("ED") category is to assist businesses which expand the state’s economic base and which create quality jobs principally benefiting employees in the low-to-moderate ("LMI") income levels. CDBG is a funding source from the U.S. Department of Housing and Urban Development ("HUD"). The federal statutory authority for the CDBG program is the Housing and Community Development Act of 1974, as amended ("HCDA"), codified at 42 U.S.C. §5301 et seq. CDBG funds will be utilized for providing communities (and counties) with resources to assist businesses which expand the state’s economic base and which create or retain quality jobs principally benefiting LMI persons and made available under the LMI, SBA, or Urgent Need CDBG National Objective criteria. Eligible Applicants: Eligible applicants include every Nebraska incorporated municipality under 50,000 population; and every Nebraska county.

• An eligible municipality may apply only for project activities within its jurisdictional control (as defined below). • An eligible county may apply only for project activities:

o within its jurisdictional control (as defined below), and o which are in unincorporated areas of the county; o provided however, that project activities occurring at a site of public facilities owned or controlled by

the county, even though within an incorporated area of the county, may be applied for. • In this context, jurisdictional control means: property within corporate boundaries; property within zoning

jurisdiction boundaries; property outside such boundaries which was acquired (through purchase or donation) prior to project activity implementation; and property controlled through permanent easements or other similar permanent land use/access control mechanisms.

• These jurisdictional control limitations and definitions are established by the Department under the Department's CDBG ED program, not by HUD CDBG regulations. Consequently, in circumstances deemed appropriate by the Department, exceptions to these requirements may be allowed.

Eligible Businesses: Not all businesses are eligible to be benefited businesses under the Department's CDBG ED program. For a business to be eligible under the Department's CDBG ED program, it must: • Meet the definitional criteria to be a "qualified business" as that term is defined in the Nebraska Advantage Act, as

that Act exists at the time an eligibility determination is made under these guidelines. As a basic narrative for these guidelines, the following listing summarizes the categories of businesses considered to be a “qualified business” under the Nebraska Advantage Act. The statutory text (and regulatory interpretations by the Department of Revenue) will prevail in the event of an interpretive conflict with these guidelines. “Qualified businesses” are those engaged in any one (or combination) of the following:

• Research and development • Manufacturing • Data processing • Telecommunications • Insurance • Financial Services • Distribution • Storage/Warehousing • Transportation • Headquarters (administrative) • Data Centers • Scientific Testing • Targeted export services (75% of sales outside Nebraska or to the U.S. Government: software

development; computer systems design; product testing services, guidance or surveillance systems; technology licensing)



and also, • Meet any additional eligibility criteria and not be ineligible by reason of the exclusions in these guidelines,

including: • The business must pay all employees at the project location in Nebraska at a rate of no less than

$9.00 per hour, as well as provide appropriate employee benefits, for the duration of the project job maintenance period. This maintenance period will be established as part of the Memorandum of Understanding (“MOU”) for the project.

• Non-profit businesses/organizations are ineligible. • Businesses that derive any revenues from gaming are ineligible. • Production agriculture enterprises are ineligible. These are excluded because they lack the necessary

CDBG ED program guideline requirement that there must exist extra levels of substantial and separately identifiable value-added processing being performed by employees of the production agriculture enterprise—beyond those tasks and activities of production, harvesting, and marketing normally associated with traditional agricultural production commodities. Examples of such ineligible enterprises (when they lack the extra value-added component) include: grain farming, livestock raising, raising of poultry or the production of eggs, the production of milk, fruit or nut orchards, vegetable farming including hydroponics vegetable production, and aquaculture facilities.

• Trucking enterprises, which lack the requisite storage, warehousing, or distribution extra components which would distinguish them from the usual so-called "rolling stock" enterprises, are ineligible.

The Nebraska Advantage Act can be found in the Nebraska Revised Statute Sections 77-5701 to 77-5735, or visit DED’s website for additional information. Eligible Activities and Forms of CDBG Assistance: Activities assisted with CDBG funds must be eligible under HCDA, CDBG regulations, and other HUD requirements, and also must be eligible under the Department's CDBG ED category. Generally, eligible activities include:

• loans to for-profit businesses (through the applicant community) for a variety of business purposes • public facilities (infrastructure) projects undertaken by applicant communities for economic development

purposes, where a benefiting business agrees to locate or expand premised on the infrastructure improvements and agrees to create jobs for LMI persons

• job training grants to for-profit businesses (through the applicant community) • speculative building projects or speculative industrial park prospects, in the form of conditional grants to

applicant communities (or to qualifying non-profit development organizations) for such projects; and planning for such projects

• short-term interim financing program Compliance with CDBG National Objective Requirements: All project activities must meet one of three national objectives of the CDBG program. This is a statutory requirement of the HCDA and a regulatory requirement under HUD CDBG regulations. The three national objectives are:

• benefiting low-to-moderate (LMI) income persons • aiding in the prevention or elimination of slums or blight • meeting other community development needs having a particular urgency because existing conditions pose a

serious and immediate threat to health or welfare of the community and other financial resources are not available to meet such needs

The majority of projects funded within the ED Program meet the LMI National Objective. The LMI benefit is demonstrated in nearly all projects through job creation, job retention, or both job creation and job retention, by a benefited business. Such job creation or job retention must involve the employment of persons, the majority (51% or more) of whom are LMI persons. A project activity that does not meet the applicable tests for determining whether a national objective has been met is in noncompliance with federal statutory and regulatory requirements. Repayment consequences arise in such circumstances. Maximum Amounts of Awards: $1,000,000 will be used as a guideline for an award for any one project under the CDBG ED category, further limited by maximums of $250,000 for any one job training grant and $250,000 for any one speculative building project. $1,000,000 will be used as a guideline for an award for any one speculative industrial park project under the CDBG ED category.

http://nebraskalegislature.gov/laws/statutes.php?statute=77-5701

http://nebraskalegislature.gov/laws/statutes.php?statute=77-5735



These maximums apply to the aggregate of all activities for a project other than general administration. An additional amount (above the cited maximums) for general administration of the project, can be, and normally is, awarded. Such additional amount for general administration typically ranges from $3,000 to $5,000. Maximum Amount of CDBG Loan Forgiveness to a Benefited Business: The aggregate amount of forgiveness to a benefited business from the CDBG ED category may be an amount up to the total award, and will be determined by DED. Matching Requirements: All CDBG ED category projects require a minimum 1:1 match of CDBG funds with funds from other (non-CDBG) sources. Put another way, CDBG funds can be no more than 50% of the total project cost. The one, small exception to this matching requirement is that CDBG funding for general administration of project activities does not require matching funds. Note that the matching requirement for public facilities (infrastructure) projects undertaken for economic development purposes (a particular form of CDBG assistance discussed later in these guidelines) cannot be met using the benefited business' investment, e.g., the construction of a new plant, but rather must come directly from the applicant community, and the matching funds must be invested in the infrastructure project. In addition to achieving the match as described above, Speculative Industrial Park Projects – Data Centers, as described below, can achieve their match using the following costs as well: DED approved costs associated with the infrastructure development of the site, and DED approved marketing costs associated with the promotion of the site. Application Timing: Applications for CDBG ED awards are accepted and considered on a continuous, open cycle. The Department will consider only fully complete applications. The requirements for a complete application are set forth later in these guidelines. Please note that a complete application includes having completed the environmental review process prior to submission of the application. The process of application review involves consideration and recommendation by: the Project Review Committee, the Department Director, and, finally, the office of the Governor. A formal Notice of Approval letter will be sent by the Department to an applicant community receiving application approval. The approval decision will normally be completed within one month after receipt of the fully complete application. Federal Requirements—"Strings": Applicants and benefited businesses must be aware at the outset of the existence of a host of federal statutes and regulations that have scheduling, cost, and substantial paperwork implications when CDBG funding is used for ED projects. Businesses must be prepared to accept delays and other "strings" requirements and should not harbor unrealistic expectations about the speed with which a project may develop. The following listing is by no means comprehensive. The list simply highlights three areas of the many commonly applicable "strings".

• Environmental Review: Federal statutes (the National Environmental Policy Act and HCDA) and HUD implementing regulations (24 C.F.R. Part 58) require that CDBG-assisted projects must have an appropriate environmental review process completed prior to costs for the project being incurred. This process must be documented with an appropriate environmental review record. The environmental review process and its documentation are the responsibility of the applicant unit of general local government. The entire project, often referred to in these contexts as the entire "footprint" of the project—not just the portion of the project involving CDBG-funded activities—must be aggregated when reviewing the project's environmental impact. In order for a project application to be considered complete for submission to the Department, there must be a completed environmental review process and record in place and sufficient evidence of its completion must be included with the application. Specific discussion of the environmental review requirements, including flowcharts (with timing requirements) and forms may be found in Chapter 6 “Environmental” of the Administration Manual Nebraska CDBG Program,

The time required to complete the entire environmental review varies considerably depending on the facts and circumstances of each project. The process can take a few days to as much as several months. The time requirement for this process is often underestimated by businesses and applicant communities. In many projects, clearing the environmental review "hurdle" is a time-consuming task and delays in project implementation arising from this process should be anticipated by applicants.

• The Davis-Bacon Act (and related acts): These federal statutes and their implementing regulations require

that federally-assisted construction work in excess of $2,000 must have prevailing wage rates (determined by the U.S. Department of Labor) paid to all employees working on such construction work. If CDBG funds



assist even just a portion of the construction work, then Davis-Bacon becomes applicable to the entire construction work. Note however, that CDBG funds can finance activities other than construction work, without triggering Davis-Bacon requirements, even though CDBG funds are "in the mix" of an overall project which may involve construction work. Note also that use of matching funds (from non-CDBG sources) for construction work does not trigger Davis-Bacon requirements.

• HUD Required Employee Reporting, Business Financial Reporting, and Other Record Keeping

Requirements: The benefited business and the applicant governmental unit have various, periodic, employment and financial reporting and record keeping requirements pursuant to CDBG regulations. The benefited business must keep a record of the Employee Certification Form (a self-certification of household income that is used for determining low to moderate income status for new hires or for a retention survey). Grantees are required to submit semi-annual Project Status and Job Creation Reports and final reports necessary for close-out of the grant. Requirements for retaining records are addressed in the CDBG Contract.

Other Considerations Affecting Project Eligibility: Intrastate Relocation. CDBG ED funds cannot be used in a project which relocates a business from one Nebraska community to another Nebraska community, unless the business obtains the written approval of the appropriate community officials of the community which is losing the business. This has been a longstanding policy of the Department, designed to avoid putting the Department in the position of financially enabling a "raid" of one Nebraska community by another. It is the responsibility of the business to resolve matters with the community from which it is departing, in order to obtain the approval by that community required by the Department. In addition to such community approval, the Department must conclude there are compelling business reasons for—and compelling public benefits associated with—the relocation, in order to assist such an intrastate relocation. Additionally impacting intrastate relocation is the job-pirating prohibition in the HUD CDBG regulations (explained below). These prohibitions may be applicable to, and possibly pose a barrier to, using CDBG ED funds for relocating a business from one Nebraska community to another Nebraska community. Prohibition on Use of CDBG Assistance for Job-Pirating Activities. The federal statute [HCDA, codified at 42 U.S.C. §5305(h)] and implementing regulations issued by HUD [24 C.F.R. §570.482(h) for state programs, effective June 23, 2006] establishing this anti-pirating policy, prohibit the state (and state grantee communities) from using CDBG funds for "job-pirating" activities that are likely to result in significant job loss in the Labor Market Area (LMA) from which the business is relocating. The regulation basically targets businesses that move (or expand) existing operations from one LMA to another LMA. Relocations within a LMA are not subject to the regulations. The regulations prohibit providing CDBG funds to for-profit businesses (including expansions of existing businesses) if the funding will assist in the relocation of a plant, facility, or operation (terms defined in the regulations)—and—if the relocation is likely to result in a significant loss of jobs in the LMA from which the relocation occurs. A "significant job loss" is not defined in the statute, but is defined in HUD regulations. The regulation uses measurements of:

• 500 jobs lost in a LMA as being definitionally a significant loss; and thus CDBG funds cannot be used in such cases.

• 25 or fewer jobs lost in a LMA as being definitionally not a significant loss; and thus not a job-pirating problem, so CDBG funds can be used in such cases.

• 26-499 jobs lost may be a significant job loss if the lost jobs are equal to or greater than one-tenth of one percent (0.1%) of the total number of persons in the labor force of the LMA from which the proposed business relocation would occur. As an example, 26 jobs lost would be a significant job loss in a LMA with a labor force size of 26,000 people.

Grants to communities for infrastructure improvement that aid the relocation of a specific business, and which are justified for CDBG funding as meeting the national objective of benefiting LMI persons through job creation/retention agreement by a specific business, are covered by this anti-pirating rule, being considered the same as directly assisting the relocating business. Under the regulations a job will be considered to have been relocated if positions are eliminated at an existing operation within three (3) years of the time when CDBG funding assistance was provided to the expansion site operation of the business.



Certifications (by the business, as to non-relocation of jobs) are required by the regulations to be part of the agreement which governs CDBG assistance to the business. These certifications are made by the business, not by the grantee community. The business must also contractually agree that if significant job losses do occur (within a 3-year window) at an existing location from which an expansion was CDBG assisted, then the business will reimburse the CDBG recipient (the community) for CDBG assistance provided to the business (directly) or expended on behalf of the business (e.g., infrastructure improvement project). These certifications and agreements to reimburse, by the business, must be a part of the MOU for the project. The community being provided CDBG funding by the Department has the burden of collecting the necessary labor force data and determining whether a significant job loss will occur as a result of the proposed relocation. This assessment will be part of the normal "packaging" and application process for the project. States are permitted (but not required) to determine/define applicable Labor Market Areas (LMAs) in non-metropolitan areas of the state. If this is done for Nebraska, the Department will make its determinations known, through these guidelines or other publication methods. If no differing definitions are made by the Department, the LMAs defined by the U. S. Department of Labor will be used. At the time of the writing of this portion of these guidelines: the "default" designations of the LMAs are found at the Bureau of Labor Standards website at→http://www.bls.gov/lau/lmadir.pdf; and labor force data by county (annual averages) are found at the Bureau of Labor Standards website at →http://www.bls.gov/lau/home.htm. The HUD regulations in this area are fairly lengthy and filled with definitions, exceptions, time limits, reporting requirements, and explanations. The guidelines explanations above are not intended to be a full explanation of this rather complicated set of newly imposed (in 2006) CDBG restrictions. The full text of the regulations must be read and understood in order to achieve compliance. The publications of the regulations by HUD appear in the Federal Register for December 23, 2005, Volume 70, Number 246, pages 76362-76371—and—in the Federal Register for May 24, 2006, Volume 71, Number 100, pages 30026-30027. These Federal Register pages have been reproduced on the Department's website [look for the bulleted pdf files "HUD Regulations on Anti-Pirating (2006 final rule, adopting the interim rule)", and "HUD Regulations on Anti-Pirating Activities (2005 interim rule)"]. Program Income and Reuse Plans: Program income for the state's program under the CDBG ED category is regulated by the provisions of 24 C.F.R. §570.489(e). The text of this regulation should be consulted for definitions and for other guidance concerning program income. Grantees that receive a CDBG ED award will be governed by the policies written in the Department’s Annual Action Plan and the (5-year) Consolidated Plan section “Program Income”. Related policy guidance can be found in the Department’s Nebraska Community Development Block Grant Program Administration Manual in Chapter 8 “Program Income”. The State CDBG objective for program income is to provide adequate financing for local development to ensure Nebraska's economic prosperity and to use all resources in a timely manner. The State is seeking to provide a policy for use of program income that coordinates local and State resources to the fullest extent possible. The State is responsible for ensuring that program income at the State and local levels is used in accordance with applicable federal laws and regulations. Program Income – Definition: Program income is defined as gross income received by a State, a unit of general local government, or a subgrantee of the unit of general local government that was generated from the use of CDBG funds, regardless of when the CDBG funds were appropriated and whether the activity has been closed out, except in limited circumstances [See also 24 CFR 570.489(e)(2)]. When program income is generated by an activity that is only partially assisted with CDBG funds, the income must be prorated to reflect the percentage of CDBG funds used. All program income is and remains subject to all requirements of the HCDA and CDBG regulations. Program income which may become a part of a Department approved community CDBG revolving loan fund remains subject to all requirements of the HCDA and CDBG regulations. This means all loans made from such a fund, including second and subsequent generation loans, are, and continue to be, subject to all CDBG requirements. Program income includes, but is not limited to, the following: (1) Proceeds from the disposition by sale or long-term lease of real property purchased or improved with CDBG funds except in instances where the proceeds are received more than 5 years after expiration of the grant agreement between the state and the unit of general local government.” [See also 24 CFR 570.489(e)(2)(v)];



(2) Proceeds from the disposition of equipment purchased with CDBG funds; (3) Gross income from the use or rental of real or personal property acquired by the unit of general local government or subgrantee of the unit of general local government with CDBG funds, less the costs incidental to the generation of the income; (4) Gross income from the use or rental of real property, owned by the unit of general local government or other entity carrying out a CDBG activity that was constructed or improved with CDBG funds, less the costs incidental to the generation of the income; (5) Payments of principal and interest on loans made using CDBG funds; (6) Proceeds from the sale of loans made with CDBG funds, less reasonable legal and other costs incurred in the course of such sale that are not otherwise eligible costs; (7) Proceeds from the sale of obligations secured by loans made with CDBG funds, less reasonable legal and other costs incurred in the course of such sale that are not otherwise eligible costs; (8) Interest earned on funds held in a revolving loan fund's cash balance interest-bearing account; (9) Funds collected through special assessments made against nonresidential properties and properties owned and occupied by households not of low and moderate income, if the special assessments are used to recover all or part of the CDBG portion of a public improvement; and (10) Gross income paid to a unit of general local government or subgrantee of the unit of general local government from the ownership interest in a for-profit entity acquired in return for the provision of CDBG assistance. Program Income – Same Business/Same Activity Rules: Federal regulations also allow the State to require the return of program income provided the local government has an opportunity to retain the program income if the program income will be used to continue the activity from which is was derived. The State is permitted to define “continuing the same project activity.” For the purposes of program income, “continuing the same project activity” will be defined as:

• For local governments with existing program income in an existing Local ED Revolving Loan Fund (sometimes referred to as a “Re-Use Fund”), or who are currently utilizing the NDO process (see below), continuing the same project activity will include providing assistance for the same CDBG eligible activities as defined in the grantee’s new DED-approved Local Program Income Reuse Plan (also known as a Local Reuse Plan).

• For newly awarded economic development grantees, with new program income that may be deposited into an

existing Local ED Revolving Loan Fund; a new Local ED Revolving Loan Fund; or who may be utilizing the NDO process, continuing the same project activity will include providing assistance to the same business for the same activity for which it was originally funded.

Economic Development Program Income Options: The unit of general local government (also known as the local government or “UGLG”) has the following options for utilizing CDBG program income that a local government may receive. These options include:

1) Returning the program income funds to DED; 2) Using the program income within an existing Local ED Revolving Loan Fund; 3) Establishing a Local ED Revolving Loan Fund; or 4) Utilizing the NDO process.

Funds in a Local ED Revolving Loan Fund are federal and are subject to all applicable CDBG rules and regulations. Of these options, the Department prefers and encourages UGLGs to utilize the NDO process first, and if not available, then to return the program income funds to DED (due to the complex nature of administering the funds). If the local government wants to keep the program income (in conjunction with the Revolving Loan Fund options), be aware that the “same activity, same business” rules make re-use of the funds problematic and difficult. These options are explored more fully in the section “Program Income” Chapter 8 of the CDBG Program Administration Manual. Program Income -- Utilizing the NDO process:



A unit of general local government may seek to form a sub-grantee relationship with a local nonprofit organization to carry out the CDBG activities on behalf of the local government. The local government funded by the State for an ED project, or a local government with an existing Local ED RLF, would grant the CDBG funds awarded to a Nonprofit Development Organization (NDO), such as a community development organization or a local economic development corporation. The NDO must be recognized (through an application process) by the State according to the requirements of 24 CFR 570.204 to carryout funded activities through a contract with the local government grantee for activities in which it retains a direct and controlling involvement and responsibilities for the provision of financial assistance to the community’s ED project. The NDO process includes, but is not limited to, the following: • The local government, which is a recipient or grantee of State CDBG funds, wishes to make a loan to a for-profit

business for economic development activities in accordance with the State’s program requirements. • The local government executes an agreement with the NDO and sub-grants the funds to the NDO, which executes

the loan agreement for the CDBG funds loaned to the for-profit business. The NDO, the local nonprofit organization, would use the repayment of the funds from the for-profit business to make additional loans, such as for economic development activities.

• The repayment of the CDBG loan is made to the NDO, and not to the local government, and the NDO retains the payments for future use through a Revolving Loan Fund (RLF), which includes a NDO Reuse Plan approved by DED through the NDO designation application process. The approved NDO Reuse Plan must ensure that activities funded by the RLF meet broad based economic development objectives. The funds repaid to the NDO to continue economic development activities would not be considered program income.

• The NDO reinvests in the community through its established RLF, which can fund additional loans in the service area of the NDO.

As an example of this process, the NDO would carry out the activities of the grant awarded to the local government for assistance to the for-profit business. During this period, the local government would ensure that all CDBG rules and regulations were followed for this initial loan. The repayments from the business to the NDO’s RLF would not be considered program income provided that the business meets the national objective requirements. Subsequent loans by the NDO using those funds repaid to the RLF would only have to meet those requirements in the DED-approved NDO Reuse Plan established by the NDO. Funds would be reinvested in broad based economic development activities. It will be the responsibility of the local government, in coordination with the NDO, to determine the entity responsible for carrying out the activities of the ED project and the entity that will be responsible for administering the project. In some instances there may be one entity carrying out the project activities and a separate entity administering the grant. Grant administration and carrying out CDBG activities on behalf of the local government grantee are two separate activities. Program Income – The NDO Process and “De-federalizing” the Funds: If the benefited business repays the loan to the NDO and achieves the national objective, the funds are no longer subject to the Federal CDBG requirements, but are considered to be “de-federalized”. Subsequent re-use of the “de-federalized” funds by the NDO are not subject to continuing CDBG restrictions, but are instead allowed to be used in accordance with the approved NDO Re-Use Plan. The funds in this case, after repayment to the NDO, are no longer considered to be Program Income, and thus are not subject to the requirements of the HCDA and CDBG regulations.



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Principal phases in the process of approval of CDBG ED projects:

• An initial expression of interest by a business wanting to utilize the CDBG program to locate or expand in a particular community, leading to preliminary eligibility and "fundability" review by economic development representatives from the community and from the Department.

• If basic thresholds of eligibility are satisfied, further discussion and information assembly and review will be

conducted by interested stakeholders. These stakeholders are typically the Department, benefiting business, financial institutions and others providing project funds to the business, and the applicant unit of local government. Particulars are refined, various issues are identified and resolved, financial commitments from non-CDBG funding sources are obtained, and the project may be preliminarily discussed between Department packaging staff and the Department's Project Review Committee. The environmental review process (discussed elsewhere in these guidelines) is normally ongoing at this stage of project development. Eventually, all necessary stakeholders involved in the project make their project commitments in a written agreement required by the Department for all projects, called a Memorandum of Understanding ("MOU"). The form and content of the MOU must be acceptable to the Department and must satisfy various regulatory requirements of the CDBG program. This is best accomplished by having the MOU drafted by the Department and then reviewed by other parties (and modified as necessary to reach a mutually satisfactory agreement). The Department is the last party to sign the MOU, and this occurs only if, and not until, a project is approved.

• The project enters a phase where the formal application is prepared and submitted to the Department for

review. In the review process, the application serves as the final, complete documentation package for consideration of project approval (or not) by: o the Department's Project Review Committee; and then, o by the Department's Director; and then, o by the office of the Governor. o If the Governor's office approves the project, the Department issues a Notice of Approval.

• Such Notice of Approval is the official notice of the approval of the award. No other communication or

document, oral or written, from any other source, substitutes for the Notice of Approval issued by the Department. The Notice of Approval will, in normal circumstances, also contain additional language authorizing proceeding with project activities (including hiring employees), and authorizing incurring project costs. Note that at this point these authorizations are allowed by the Department to accommodate the usual desire of the business to proceed as quickly as possible with project implementation—but at this point, lacking a Notice of Release of Funds, the community and the business incur costs at their own risk.

• When all conditions required by the administrative contract between the Department and the unit of local

government have been satisfied, the Department issues a Notice of Release of Funds. Issuance of a Notice of Release of Funds is the final step, which allows project to be fully authorized to be paid under the CDBG award and reimbursed by the Department to the community (and further passed-through to the business).

The review process by the Department Project Review Committee is based on the individual and collective judgments of Committee members, in consultation with other Department staff as necessary, applying an objective scoring process based on various criteria. A group/consensus decision is reached evaluating the merits of each application and deciding whether to fund, and if positively determined, at what level of funding. Applications for CDBG ED awards are accepted and considered on a continuous, open cycle.



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UUNNDDEERRWWRRIITTIINNGG && DDEECCIISSIIOONN--MMAAKKIINNGG CCRRIITTEERRIIAA The Housing and Community Development Act (HCDA) and HUD's CDBG regulations outline basic project "underwriting" guidelines/standards so that state programs administering federal CDBG funds will achieve the federal objectives of the CDBG program. The underwriting standards—the decision-making criteria—used in the Nebraska CDBG ED category are designed to address these federal guidelines. The federal CDBG guidelines, as applied by the Department, may be summarized as follows:

1. Project costs must be reasonable, not excessive, and must be supported by cost analyses. Transactions must be carried out through arms-length transactions, not insider arrangements.

2. All proposed sources of financing necessary to carry out the project must be committed. This ensures that time and effort is not wasted on assessing proposals, or awarding funds to projects, that are not in a position to proceed to project completion within a reasonable time. To fulfill this requirement, the Department requires a written verification affirming the various funding parties' intentions to make funds available, and, depending on the nature of the funding party, a showing of their capacity to actually provide such funds.

3. To the extent practicable, CDBG funds are not to be substituted for other funds. This standard requires a financial underwriting analysis of the project. The level of analysis will vary with the nature and complexity of the project. Since projects in this category provide financing for for-profit businesses, appropriate levels of private source financing (e.g., bank loans) are expected to be present, and equity participation in the project must be sufficient given the financial capacity of those owning the enterprise.

4. Financial feasibility of the project. The public benefit expected from the investment of CDBG funds is the creation and maintenance of LMI jobs. That benefit will not materialize if the project is not financially feasible.

5. Avoidance of providing an unreasonable return on investment to the owner of the project. The availability of non-interest bearing loans and forgivable loans to for-profit businesses presents a potential for this to occur which must be addressed in analyzing, and in judging the merits of, each project.

6. To the extent practicable, CDBG funds should be disbursed on a pro rata basis with other project funding sources. CDBG money should not be the first money into a project, but rather should flow into a project in proportion to other project funding sources.

Applicants must recognize that CDBG ED funds are limited and not all applications are equally meritorious when viewed from the Department's state-wide perspective. Decisions on applications by the Department Project Review Committee are based on the individual and collective judgment of Committee members, in consultation with other Department staff as necessary, applying analyses of objective criteria considered to be useful and important in assessing whether to spend scarce federal CDBG dollars on a proposed project and in distinguishing among competing applications. A group/consensus decision is reached evaluating the merits of each application and deciding whether to fund, and if positively determined, at what level of funding.



Application Decision-Making Criteria: The general scoring criteria for the Program include 110 points available for any application. These criteria include: CDBG Funds Utilization; Community Impact and Investment; Business Factors; and Economic Development Certified Community. The Department's Project Review Committee considers the following criteria, and uses the following scoring spectrum, when evaluating whether an application meets the minimum threshold requirement. A project scoring less than 25 points does not meet the minimum threshold for further consideration by the Project Review Committee. Scoring 25 points is a necessary condition for further consideration, but is a minimum threshold only and is not solely determinative of a favorable recommendation by the Project Review Committee for awarding CDBG funds based on the application.

• CDBG $ Utilization→ 35 points possible for this component

o CDBG $ invested per job created/retained→ 20 points possible

0 points = $35,000 or more 4 points = $30,000 to <$35,000 8 points = $25,000 to <$30,000 12 points = $20,000 to <$25,000 16 points = $15,000 to <$20,000 20 points = <$15,000

o CDBG $ compared to total project $ (as %)→ 10 points possible

0 points = 50% 2 points = 33% to <50% 6 points = 20% to <33% 10 points = <20%

o Aggregate wages (and benefits) paid to employees in created jobs within one year compared to CDBG $

invested (as %)→ 5 points possible

0 points = 100% or less 2 points = >100% to <125% 5 points = 125% or more

• Community Impact and Investment→ 30 points possible for this component

o Location of community as more economically distressed than others, based on three broad location

sectors→ 20 points possible

5 points = larger community/county locations: Beatrice, Columbus, Fremont, Grand Island, Hastings, Kearney, Norfolk, North Platte, Scottsbluff/Gering, South Sioux City, Douglas County, Lancaster County, and Sarpy County

10 points = not one of the larger community locations, but in the Interstate-80 corridor 20 points = rural (encompassing all locations not within the two location sectors above)

o Due to the nature of Speculative Buildings and Speculative Industrial Parks, 10 points are being awarded to

these projects as other factors cannot be determined at this time → 10 points possible

• Business Factors→ 40 points possible for this component

o Owners' equity in project→ 12 points possible

0 points = 10% or less 4 points = >10% to 20% 8 points = >20% to 33% 12 points = >33%

o Loan collateral, and loan guarantees→ 6 points possible



0 points = unsecured, or a junior lien position offering little realizable value 1-5 points = for the spectrum in between 6 points = reasonably secured as to collateral value and liquidity, with guarantees in existence

o Established business, or start-up venture→ 6 points possible

0 points = start-up venture with all the usual risks of failure 3 points = established business, but with negative trends 6 points = established business with positive trends

o Documentation of $ commitments by all other project $ sources→ 4 points possible

o Duration of commitment to maintaining the created/retained jobs→ 2 points possible

0 points = committing to maintaining only for the minimum required by the Department's guidelines 2 points = committing to substantially more than the minimum

o Targeted Industry→ 10 points possible

• Economic Development Certified Community→ 5 points possible for this component

o If the applicant community is qualified as an Economic Development Certified Community, 5 bonus points

are given→ 5 points possible Total Project→ 110 points possible for total of all components




PPRROOGGRRAAMM SSPPEECCIIFFIICCSS Additional Information and Documentation that may be required with your application There are many more facts and circumstances surrounding a business economic development project which are not contained within the basic application form and the basic exhibits. A complete application requires much more information in order for the Department to determine all applicable project eligibility requirements and to apply its underwriting guidelines to further assess the merits of the application. Consequently, the applicant must provide additional, comprehensive information, in formats appropriate to the type of information (i.e., there are no "forms"), which reveals and explains the project's eligibility; viability; impact on jobs and ability to meet the LMI national objective; business component factors; and community impact and commitment. Applicants may organize these and include them in the application materials in any logical manner. Information/documentation required for every project is subject to the Department’s discretion and includes:

• Memorandum of Understanding (MOU). Completed and signed by all parties (other than DED). The terms of the MOU serve to fulfill many CDBG regulatory requirements, so these MOUs are drafted by DED project staff in conjunction with other stakeholders in the project. The MOU is a joint agreement among the parties—the drafting function is simply spearheaded by DED staff. The MOU normally serves as the funding commitment document for all project funding parties. It is necessary to adequately document the commitment to funding by the various funding parties. For those sources of funding which are not parties to the MOU (as might be the case for a bank), the application must include separate, satisfactory documentation of the commitment to the project by such funding sources who are not signatories to the MOU.

• A summary of the essential terms of the CDBG funded loan, including collateral requirements, maturity, and

personal guarantees of the loan by principals of the business.

• A discussion of the reasonableness of project costs, including where appropriate for the particular project, cost estimates, appraisals, and engineering estimates.

• A showing of the citizen participation in the project required by the CDBG regulations, normally in the form of

documents reflecting: the required Public Hearing Notice having been published and posted; the holding of the public hearing; and the outcome including a summary of any citizens' comments about the project.

• A showing of appropriate resolution of any intrastate relocation issues or national "anti-pirating" issues (refer

to discussion of same earlier in these guidelines).

• A map of the location of the proposed project that shows the site in appropriate context for the community involved. Its purpose is to provide the Department with a rudimentary image of the business location which is often not obvious from site addresses and project narratives. See the Exhibits for detailed discussions.

• The written business plan associated with the project.

• Resumes of principals and other key personnel of the business.

• Historical, and pro forma, financial statements for the business (include any audited statements also):

o balance sheets, cash flow statements, and income statements for up to three years (if applicable), and o pro forma balance sheets, income statements and cash flow statements for two years

• Financial statements and/or federal income tax returns of personal guarantors, if applicable.

• A written, comprehensive, narrative, project summary addressing project viability, eligibility, ability to fulfill the

LMI national objective, ability to repay the CDBG loan, financing commitments having been achieved, and the basic readiness to implement the project.

• Any additional information which in the judgment of the applicant would fully support the application.



Compliance with CDBG National Objective Requirements Your attention is directed to the general discussion of this subject in the Overview of General Requirements, found earlier in these guidelines. In that discussion, the CDBG national objective requirement of benefiting low-to-moderate income persons, through job creation and/or job retention by a benefited business is cited. Such job creation (or job retention) must involve the employment of persons, the majority (51% or more) of whom are LMI persons.

• It is required for every project that a CDBG national objective be met. Failure to achieve a national objective has repayment consequences for the benefited business. In the case of public facilities projects, failure to achieve a national objective has repayment consequences for both the business and the applicant community.

• The CDBG national objective of benefiting LMI persons is the one normally applicable to CDBG ED projects.

• Benefiting LMI persons is normally achieved by creating jobs where more than half of such jobs (actually 51%

or more) are held by LMI persons. The 51% LMI requirement applies to all jobs created as a result of project activities—it does not just apply to the number of jobs to be created which is agreed by the Department as the minimum number of jobs required to be created. This is an important point often overlooked or misunderstood by parties to CDBG project agreements.

• Occasionally, in limited circumstances, rather than the job being held by an LMI person, a lesser standard of

compliance, called making the job available to LMI persons, may be substituted. However, this "available to" standard is a less satisfactory choice, and compliance with the "available to" standard requires compliance with fairly rigorous regulatory standards. Specifics about how an employment position is considered to be "held by" or "made available to" an LMI person, and other related definitional matters, may be found in the HUD CDBG regulations in 24 C.F.R. Part 570. More detailed discussion can be found in the HUD’s Guide to National Objectives and Eligible Activities for State CDBG Program, which provides some guidance on using the “available to” standard:

o Jobs that are not held (filled) by LMI persons may be claimed to be “available to” LMI persons only when both of the following are met:

The jobs do not require special skills that can only be acquired with substantial (i.e., one year or more) training or work experience, and education beyond high school is a not a prerequisite to fill such jobs, unless the business agrees to hire unqualified persons and train them, and

The state grant recipient and/or the assisted business takes actions to ensure that LMI persons receive “first consideration” for filling such jobs. “First consideration” involves the following principles:

• The business must use a hiring practice that under usual circumstances would result in over 51 percent of the LMI persons interviewed for applicable jobs being hired,

• The business must seriously consider a sufficient number of LMI job applicants to give reasonable opportunity to fill the position with such a person, and

• The distance from residence and availability of transportation to the job site must be reasonable before a particular LMI person may be considered a serious applicant for the job.

o When demonstrating that at least 51% of the jobs created will be available to LMI persons, documentation for each assisted business must include:

A written commitment by the business that it will make at least 51% of the jobs on a FTE basis available to LMI persons and will provide training for any of those jobs requiring special skills or education;

A listing by job title of employees at the time of application for assistance is submitted; A listing, by job title, of the total permanent jobs to be created, indicating which jobs will be

available to LMI persons, which jobs require special skills or education, and which jobs are part-time;

Evidence supporting the total number of jobs; A description of actions to be taken by the recipient and the business to ensure that LMI

persons will receive first consideration for these jobs; A listing, by job title, race, ethnicity, gender and handicapped status of the permanent jobs

created; which jobs were made available to LMI persons; and, a description of how first consideration was given to such persons for those jobs. The description should include the



hiring process used; the number of LMI persons considered for each job; and the number of LMI persons actually hired;

A description of how the LMI persons status (of those given first consideration) was determined; and, a description of the total number of jobs was determined.

• Job Retention vs. Job Creation.

o In order to consider jobs as being retained as a result of CDBG assistance, there must be clear and objective evidence that permanent jobs will be lost without CDBG assistance. The mere assertion of such a circumstance (by the business or representatives of the applicant community) is not sufficient to meet HUD CDBG requirements. Clear and objective evidence would include: Evidence that the business has issued a notice to affected employees that their jobs are at risk Evidence that the business has issued a public announcement to that effect An analysis of relevant financial records of the business clearly and convincingly shows that the

business is likely to have to cut back employment in the near future without the planned CDBG intervention

o When job retention (rather than job creation) is invoked to meet the national objective, 51% of more of the

retained jobs must be demonstrated as being held by LMI persons at the time of CDBG assistance (by conducting a “retention survey” using the Employee Certification Form with existing employees).

Low-to-Moderate Income Person (LMI): LMI persons are defined as members of a family (single-person family or multi-person family) where the family has an income equal to or less than the most recent HUD-established income limits for the family residence location. In Nebraska (with some exceptions for metropolitan statistical areas) the income limits are determined for each county. These income limits may be found via the HUD website. A job is considered to be held by an LMI person if the person is, at the time their employment commences, a member of a family whose income falls within the HUD determined income limits. The family's entire income must be counted. The salary or wage associated with the job the LMI person fills is irrelevant. Full-Time Equivalent Position (FTE): An FTE position represents a culmination of 2,080 work hours per annum per position by a person in a permanent position of employment with a benefiting business at the business' project location site in Nebraska. Permanent FTE Jobs are Required: Only permanent jobs count. Temporary jobs do not count. Permanent jobs are full or part-time positions at the benefited business at the specified project site, which can reasonably be expected to be occupied for at least six continuous months. Seasonal jobs may be considered to be permanent only if the season is long enough for the job to be considered as the employees' principal occupation. All permanent jobs must be converted to FTEs. Expectations for the Normally Allowed "Ramp- up" Time; Normally Required Job Maintenance Period: The Department's expectation for the normally allowed "ramp-up" time for the business to create the required jobs is 18 months from the Notice of Approval for the project. Longer durations of this ramp-up time are allowed in some project circumstances. Shorter durations may be imposed in some project circumstances, e.g., CDBG-funded job training projects involving only a few employees may well be allowed a ramp-up time of only 12 months. The normally required time for the business to maintain the created jobs is negotiable (usually 6 to 24 months), measured from the date of hire for each respective job. More nuanced and complicated definitions of the beginning and ending dates of the job maintenance period may be invoked in project negotiations (and their resulting MOUs) in some circumstances. These ramp-up times and job maintenance periods are established by agreement of the parties in the MOU. Aggregating Jobs: As a general rule, jobs from each business receiving CDBG assistance must be considered separately for purposes of demonstrating compliance with the requirements that at least 51% of the resultant created or retained jobs benefit LMI persons. Certain fact settings, e.g., an industrial park, may allow job aggregation for all businesses located on the property. Particulars about such circumstances are found in the CDBG regulations and other HUD materials. Repayment by the business due to failure to fulfill the national objective’s job creation/maintenance requirements: When the CDBG assistance provided to a business is in the form of a repayable loan, then full repayment of that loan is required per the terms of the promissory note. If the business with the repayable loan obligation fails to achieve a national objective, the consequence is that immediate acceleration of the note obligation will be declared, requiring immediate, full repayment of the note. When the CDBG assistance provided to a business is wholly, or partly, in the



form of a forgivable loan or a job training grant, and the business fails to achieve a national objective or related job creation or job maintenance requirements, the consequences vary depending on the nature of the failure:

• CDBG federal statutes and regulations require CDBG funded projects to meet the national objective of principally benefiting low-to-moderate income (LMI) persons. These statutes and regulations require that at least 51% of the created jobs benefit LMI persons; with such benefit achieved by having at least 51% of the created jobs either held by, or made available to, LMI persons. If the benefited business fails to meet the national objective by not having at least 51% of the created jobs benefit LMI persons, then the loan is not forgiven or the job training grant is not made unconditional, and full repayment of the CDBG funds is required.

• If the national objective (51% LMI benefit) is met, but the minimum job creation requirement (the number of

such jobs varying with each individual project) is not achieved, then full repayment of the CDBG funding is required of the business absent other agreement by the Department.

• If the national objective (51% LMI benefit) is met, but the jobs are not maintained for the required job

maintenance period (such period varying with each individual project), then full repayment of the CDBG funding is required of the business absent other agreement by the Department.

• If the national objective (51% LMI benefit) is met, but there is a failure as to both the job creation requirement

and the job maintenance period, then full repayment of the CDBG funding is required of the business absent other agreement by the Department.

SAM Registration The System for Award Management (SAM) is combining federal procurement systems and the Catalog of Federal Domestic Assistance into one new system. This consolidation is being done in phases. Any government, business, grantee or organization wishing to do business with the federal government under a Federal Acquisition Regulation (FAR)-based contract, or anyone applying for federal grants, cooperative agreements or other forms of federal financial assistance through Grants.gov, must be registered in SAM. Also, consider creating a SAM account if you wish to utilize the full set of capabilities that have been developed in SAM. All Project Applicants must be registered with the System for Award Management (SAM). HUD will not issue a grant agreement for awarded funds to a project applicant until an active SAM registration is verified. If you had an active record in the Central Contractor Registry (CCR), then you have an active record in SAM. If you did not have an active record in the CCR or if your organization’s record expired, you will need to register your organization in SAM. Please visit the System for Award Management website, www.SAM.gov to register or update your organization. You will need to create a user account before registering or updating your organization. The SAM will ask you for the North American Industry Classification System or NAICS code that best describes your industry. The website has detailed instructions and user guides to assist in registering your organization. See the Exhibits for more details. DUNS Number A DUNS Number, assigned by the company Dun & Bradstreet, is required when submitting any application for Federal funds. If your organization does not already have a DUNS Number, please visit the Dun & Bradstreet website at www.dnb.com or call 1-866-653-1344. The process of obtaining a DUNS Number is free of charge and should take less than 15 minutes. Most organizations will have a 9-digit DUNS Number. Larger organizations that have multiple departments might already use 4-digit extensions on the DUNS Numbers to distinguish between the various offices with the organization. For example, of a State DUNS Number is 123456789, the Housing, Health, and Transportation Departments should all have different 4-digit extensions, especially since these departments might have different addresses and contact personnel. The 13-digit numbers would look like 123456789-1234. In e-snaps, however, the hyphen is NOT entered. See the Exhibits under “Instructions for SAM Registration” for more details. Eligible Activities and Forms of CDBG Assistance Activities eligible for assistance under the CDBG ED guidelines are primarily (but not exclusively) authorized in Sections 105(a)(14, 15, 17) of the HCDA. All activities must meet the eligibility requirements, and avoid the prohibitions, in the HCDA and in the CDBG regulations. The forms of assistance available in the CDBG ED category are:

• Loans to businesses: The provision of "direct" assistance to eligible, private, for-profit businesses to carry out an economic development project. The assistance is not (and cannot be by the provisions of the HCDA and the CDBG regulations) provided directly to the business from the Department, but rather is passed through the applicant governmental unit. The assistance will be in the form of a loan from the applicant governmental



unit to the business. Such loans may be used by the business for almost any legitimate business purpose. Examples of permitted uses include: purchasing land; constructing a building; renovating an existing building; purchasing machinery and equipment; purchasing inventory; and meeting working capital needs. Unless a compelling case, involving extraordinary circumstances, can be made by the applicant and the benefited business—refinancing/financial restructurings/"bail-outs" of existing debt are not favored by the Department as an appropriate use of CDBG funds. o Loans to businesses may be either low-interest or non-interest bearing, depending on: interest rate

market conditions; the particular facts and circumstances of the business and the CDBG application; and the decision regarding loan terms (interest rate being among such loan terms) made by the entity which will be ultimately receiving loan repayments made by the business (which may be the applicant governmental unit, or the Department, or both in some instances).

o Loan amortizations are to require monthly payments. o Other terms of the loan (such as appropriate loan maturity, payment deferrals, and collateral

requirements) vary from project to project and will be subjects of negotiation among the parties. o Maximum allowed maturities are:

15 years for real estate loans 7 years for machinery/equipment loans 5 years for working capital loans

o Maximum time for deferral of the initial loan payment is one year from note inception. Such payment deferrals are not the norm.

• Public facilities (infrastructure) construction or improvement projects, undertaken for economic development

purposes: CDBG funds in these instances are granted directly to the community. In such projects, a business benefiting from the infrastructure project (e.g., from street construction to the proposed site of the business) agrees to locate or expand in the applicant community premised on the infrastructure project and agrees to create jobs principally benefiting LMI persons (and to maintain those jobs). o The public facilities project must be essential to the business and have a direct nexus to the business

activities conducted by the business. o Typical examples of such public facilities include street construction, street improvements, water supply

system improvements, sewer system improvements, and flood and drainage system improvements. o Communities should note that any costs for "oversizing" the project to meet community needs beyond the

essential needs of the benefited business must be exclusively paid by the community, and such costs borne for "oversizing" will not count toward the required minimum 1:1 community match of CDBG funds.

o Because the CDBG award in these projects is a grant directly to the community, the matching funds in these projects must come from the community itself and be invested directly into the project costs. Other "matching" that may be done by the business in its location/expansion, e.g., building a new plant, does not serve to fulfill the match requirement in this public facilities component of the CDBG ED program.

o Even though the CDBG funds in these projects do not flow through to directly benefit the business, the business benefits from the project, and the granting of the CDBG funds to the community in the first place is premised upon the business' agreement to locate/expand and to create and maintain jobs thereby. Consequently, the business is required to agree (in the MOU for the project): to carry out the location/expansion of its business facility. to create and maintain jobs having the required LMI benefit. to repay to the community the amount of the CDBG funds awarded to the community and invested in

the public facilities project should the business fail to meet the requirements of the MOU. to provide in the application and periodically into the future (for the duration of the job maintenance

period) financial information to allow an evaluation of the condition of the business, the likelihood of achieving the job creation and job maintenance requirements, and the business' capacity to repay to the community the amount of the CDBG funds awarded should the business fail to meet the requirements of the MOU.

• Job training grants to eligible private for-profit businesses: The basic rationale of this component of the

program is to use CDBG ED funds in assisting the business in meeting the well-recognized "on-the-job" training costs associated with hiring new employees. o These grants are only available for newly created jobs, not for retaining jobs. o The grants are conditional upon the business satisfying the requirements of CDBG regulations and upon

the business meeting its obligations as established in the MOU for the project. When the requirements and obligations are fully satisfied by the business, the grants are classified as unconditional and the business then has no further obligations to the Department.

o Those new jobs eligible for reimbursement under the grant award will be identified in the MOU for the project. All jobs are not necessarily eligible for reimbursement.



o Reimbursement of wages to the company is fundamentally based upon particular positions/jobs, as contrasted with the particular employees filling those positions/jobs. To illustrate this point, if an employee who has been filling a position leaves the business and his/her position is filled (replaced) by another existing employee, or a new employee, this is fundamentally just continuing to fill the position even though a different employee is involved. This distinction is made because neither a new "batch" of reimbursement money, nor a new "batch" of six-months of training time is available for that position simply because a different employee fills that position—the previous "batches" of reimbursement money and training time already associated with that position simply continue.

o These job training grants are paid to the benefited business (through the applicant community), as reimbursements for wages paid by the business. Reimbursements mean after the fact of payment of the wages by the business to the affected employees. These reimbursements (and the project award from the beginning) are subject to the following amount limitations: There is an absolute $250,000 maximum award. There is an absolute $10,000 per job maximum award. There will be established as part of the project award an aggregate limit for the entire project. Such

aggregate limit is usually less than the $250,000 absolute maximum mentioned above. Typically, this aggregate limit is simply the arithmetic product of the number of jobs agreed to be created for which training funds are being supplied—multiplied by—the "per job" limit for the project (explained just below).

There will be established as part of the project award a "per job" fixed dollar limit (applicable to each job for which job training funds are reimbursed), such limit applied no matter what the wages paid to an affected employee may be. The amount of this "per job" limit is heavily influenced by the most basic limitation—the 50% of the employee's wages for six months/1,040 hours—limit. In no event may the "per job" limit exceed the absolute $10,000 per job maximum mentioned earlier.

The most basic limit is that the business will not be reimbursed for more than 50% of the particular employee's wages paid for the first six months/1,040 hours of employment.

o These job training grants require the business to: Create jobs, and do so before the end of a "ramp-up" period. (if the business is an existing business with employees) agree (via the MOU) to a baseline number for

the number of present positions/jobs, above which baseline the created jobs will be considered to in fact have been created, and for which baseline the business will have an additional job maintenance responsibility (see below).

Achieve the CDBG LMI national objective by having at least 51% of all positions created (not just 51% of the minimum number of positions required to be created) be held by LMI persons.

Pay all employees at the business (not just the job training grant related employees) at the minimum rate set forth in the Eligibility Criteria for eligible businesses found elsewhere in these guidelines.

Maintain the created jobs for 24 months beginning with the date of hire for each respective job. Maintain the agreed baseline of employment for 24 months beginning with the Notice of Approval for

the project. Satisfy all other project requirements as set forth in the MOU for the project.

• Speculative buildings projects/speculative industrial park projects: This eligible activity and form of assistance

provides loans or conditional grants to applicant communities for the development of so-called "spec buildings" or "spec industrial parks". These "spec" improvements must then be later occupied by a qualifying business, which must agree to create sufficient jobs that principally benefit low and moderate income (LMI) persons in order to fulfill the required CDBG national objective. If this CDBG national objective is not fulfilled, the loan or conditional grant made to the applicant community by the Department must be repaid by the applicant community to the Department. As a guideline, $750,000 is the maximum level of assistance for a speculative industrial park project. These projects bear much more than normal risk to the applicant community (almost by definition since they are speculative as to the occupancy of the building or park by a qualifying business that may or may not generate sufficient LMI qualifying jobs). As a consequence of this risk, the Department requires that there be consultation, involvement, and coordination with Department staff at all phases of the application. Contact the Department if you plan to submit an application for a Speculative Building or Speculative Industrial Park.

• Short-term Interim Financing: This program provides short-term or interim financing for projects that create or

retain employment opportunities, prevent or eliminate blight or accomplish other federal and state community development objectives. Financing maybe used for construction or improvement of public works; purchase, construction rehabilitation or other improvement of land, buildings facilities, machinery andequipment, fixtures and appurtenances or other projects undertaken by a proprietary or nonprofit organization; assistance for



otherwise eligible projects or programs. Applications are accepted at any time and are processed, reviewed and considered on a first-come, first-served basis. DED makes funding decisions following receipt of a complete application and to the extent funds are available. Awards may not exceed $15 million.

Selection is based on the following threshold criteria: evidence of local capacity to administer the funds; acceptable performance in the administration of prior state or federal grants; feasibility the project will be completed with funds requested (the applicant must identify other funding sources and the terms of assistance); evidence the project will be completed within 30 months of the grant award date; an irrevocable letter of credit or equivalent security instrument from a lender; commitment of permanent financing for the project. If an application satisfies all threshold criteria, it is evaluated on the following:

o Does CDBG participation leverage substantial local financial participation? o Is the cost of CDBG short-term funds per person benefited reasonable? o Is the need for CDBG assistance reasonable? o Does the public benefit substantially exceed the value of assistance (measured by the present value of assistance to the direct and indirect wages and aggregate payroll lost, dislocation and potential absorption of workers and loss of economic activity)?

Special Conditions for Release of Funds Funding of amounts stipulated in the CDBG contract will not be released to the Grantee by the Department until the following special conditions for release of funds are met. These special conditions must be satisfactorily completed no later than within 90 days of the Contract begin date. The Department reserves the right to cancel the contract if these special conditions are not met within this specified time frame. The Special Conditions for the Release of Funds in the CDBG Contract must be satisfied before the Notice of Release of Funds will be issued. The list below represents a list of typical special conditions; however, CDBG contracts are tailored to a specific project with unique conditions. These (Special Conditions) forms (and instructions) can be found on the Department’s website under “CDBG Forms”, “CDBG Notices” and the Administration Manual Nebraska Community Development Block Grant Program at: http://www.neded.org/community/grants/documentslibrary-a-forms. Grantee Information Sheet. Completion, and submission to the Department, of the CDBG Grantee Information Sheet. This form can be found on the Department’s website under “CDBG Forms”. Environmental Review. Submission to the Department of documentation evidencing the Grantee's completion of its responsibilities for environmental review and decision making pertaining to the Project, and its compliance with the National Environmental Policy Act of 1969 (NEPA), and other provisions of federal law as specified in 24 C.F.R. Part 58 which furthers the purposes of NEPA as now in effect, and as such law may be amended during the term of this contract. The completed Environmental Review Record is a required submission with the CDBG application, and it may contain requirements such as environmental mitigation (such as avoiding mating season of certain bird species during the Project construction time frame, or obtaining special permissions, licenses, or permits, etc). These conditions are usually listed under “Other Special Conditions” section of the CDBG Contract. Authorization to Request Grant Funds Form. Completion by the appropriate chief elected official of the Grantee, and submission to the Department, of the Department's Authorization to Request Funds form. This form can be found on the Department’s website under “CDBG Forms” and is displayed in the Exhibits. Financial Management Certification. Submission to the Department of documentation evidencing completion of all financial management system requirements and execution of the financial management certification form prescribed by the Department. . A sample certification form can be found at the Department’s website under “CDBG Forms” and in the Exhibits. Procurement Standards and Code of Conduct. Submission to the Department of documentation evidencing adoption of Procurement Standards and Code of Conduct in compliance with provisions of federal law as now in effect, and as such law may be amended during the term of this contract, including but not limited to, 24 C.F.R. Part 85, 24 C.F.R. §570.489, and 2 C.F.R. §§200.318 through 200.326, with emphasis on the provisions in 2 C.F.R. §200.322 regarding procurement of recovered materials. Procurement standards must include written standards of conduct covering conflicts of interest and governing the actions of Grantee’s employees engaged in the selection, award and administration of contracts. An example policy can be found at the Department’s website under “CDBG Forms” Procurement Procedures and Code of Conduct.

http://www.neded.org/community/grants/documentslibrary-a-forms



Excessive Force Certification. Submission to the Department of documentation that the Grantee has adopted a policy to prohibit the use of excessive force by local law enforcement agencies against any individual engaged in nonviolent civil rights demonstrations. A sample certification form can be found at the Department’s website under “CDBG Forms” and in the Exhibits. Fair Housing Practices Submission to the Department of documentation identifying the local fair housing representative for the Grantee, including the representative’s name and contact information. The Grantee must also submit a description of the actions Grantee will take during the course of the grant to fulfill the requirements to affirmatively further fair housing, and submit documentation demonstrating the actions that were actually taken. The requirement to submit documentation demonstrating the actions that were actually taken need not be submitted within the time frame for completion of the special conditions, but such documentation must be submitted prior to closeout of the grant. The Department's Administration Manual contains additional detail about affirmatively furthering fair housing. . A Memorandum discusses affirmative fair housing actions at the Department’s website under “CDBG Forms” Fair Housing. Implementation Schedule. Completion, and submission to the Department, of the Nebraska CDBG Grantee Implementation Schedule form. The Implementation Schedule will serve as the schedule for completion of the Project, and may be used by the Department to assess Project progress. This form is shown at the Department’s website under “CDBG Forms” and in the Exhibits. CDBG Certified Administrator Required. Documentation must be submitted to the Department identifying the CDBG Certified Administrator the Grantee will use for the Project. The Department's Administration Manual contains details about the certification process. Limited English Proficiency. Submission to the Department of documentation evidencing completion of responsibilities for ensuring meaningful access to the Project activities and services for persons with Limited English Proficiency (“LEP”), as required by Title VI of the Civil Rights Act of 1964, Executive Order 13166, and HUD's final “Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient (LEP) Persons,” published in the Federal Register on January 22, 2007, and which became effective on March 7, 2007 (“HUD LEP Guidance”). Such documentation must include all of the following (1) information identifying the LEP representative for the Grantee, including the representative’s name and contact information; (2) a Four Factor Analysis that is consistent with the HUD LEP Guidance; and (3) a description of the actions the Grantee will take during the course of the grant to fulfill the requirements to provide meaningful access to LEP persons. If deemed necessary as a result of the Four Factor analysis, Grantee will prepare and submit to the Department, a Language Access Plan (“LAP”) that includes all elements of an effective LAP as defined by HUD. The Grantee must also keep records of requests for LEP services, and all LEP services provided by Grantee during the course of the grant. Grantee must submit documentation to the Department demonstrating LEP services provided. The requirement to submit documentation demonstrating the LEP services provided need not be submitted within the time frame for completion of the special conditions, but as required in §4.07, such documentation must be submitted prior to closeout of the grant. See the Department’s website for more information and a sample plan in the Exhibits. Other Special Conditions.

These conditions are usually listed under “Other Special Conditions” section of the CDBG Contract, and often reflect special conditions outlined in the Environmental Review Record.




AAPPPPLLIICCAATTIIOONN FFOORRMMSS AANNDD RREEQQUUIIRREEDD EEXXHHIIBBIITTSS CCHHEECCKKLLIISSTT

Environmental Review Record per NEPA requirements Define the Project and it’s footprint – all planned improvements, activities, and details Obtain necessary publications, certifications, and conduct public hearings, as applicable Complete the Environmental Review Record (submit with application)

Application Form and Required Exhibits

Application Form (Part I, General Information) Application Form (Part 2, Funding Summary) Exhibit A Participation Identification + Project Summary Exhibit B Project Financing and Use of Loan Proceeds Exhibit C Job Creation/Retention Information Exhibit D Applicant’s Statement of Assurances and Certifications Exhibit E Citizen Participation Plan Exhibit F Notice of Public Hearing Exhibit G Resolution Authorizing Chief Elected Official to Sign Exhibit H FFATA Reporting Form/Certification Exhibit J Program Income Certification

Other Documents Related to the Project’s Application

Map of Proposed Project Area in Community Context Memorandum of Understanding (MOU) [signed by all parties other than DED] SAM registration of Grantee (active) SAM – business and principals not on excluded parties list DUNS number – grantee and business Certificate of Good Standing (Nebraska Secretary of State’s office) Funding commitments (if not in MOU)

Business and Financial Analysis Documentation

Business plan-Business Strategy Resumes of key business personnel Business financials including balance sheet, income statement, and cash flow statements (3 years historical/2

year pro forma) Guarantors' financial statements Project cost documentation, including vendor quotes or engineering estimates for equipment purchases Borrowing resolution authorizing the business representative to borrow funds from the local government

Special Conditions to receive Release of Funds

Four Factor Analysis Assessing Limited English Proficiency Language Assistance Plan (if applicable) Financial Management Certification Procurement Standards and Code of Conduct documentation Grantee Information Sheet Authorization to Request Grant Funds Excessive Force Certification Implementation Schedule Financial Management Certification




AAPPPPLLIICCAATTIIOONN FFOORRMMSS AANNDD CCOONNTTEENNTTSS RREEQQUUIIRREEMMEENNTTSS Note that only one original of the entire application package must be submitted. No additional copies are required. Note also the Application Contents Requirements Checklist (on the previous page) as an overall summary of contents requirements. Instructions for Parts I and II of the Application for CDBG Economic Development Category Part I: GENERAL INFORMATION Box 1: Enter the name, mailing address, and fax number of the local government that is the applicant in an individual application or the lead applicant in a joint application. Enter the name, email and phone number of the local government contact person. Such person is the applicant's employee who is most familiar with the application. Box 2: Enter the name, mailing address and telephone number of the person who prepared the application. If prepared by a firm, identify the staff contact person. Check the appropriate application preparer status box. Box 3: Check the appropriate Type of Assistance box under which funds are being requested. Box 4: Check the appropriate application type box under which funds are being requested. Box 5: Enter the dollar amounts of CDBG funds requested. Enter the total matching and total other funds. Be certain that the figures are correctly added and are the same as provided on the “Total” line for each funding source in Part II. Round amounts to the nearest hundred dollars. Box 6: Give a short description of the project for which funds are requested. Include a list of other applicants if a joint application is being submitted. For a joint application, attach a copy of the written agreement. Box 7: Only the signature of the applicant's chief elected official will be accepted. Alternate signatures (e.g. city council president, city manager) are not allowed, except where there exist extenuating circumstances (e.g. chief elected official is out for an extended period), and the applicant receives prior written approval from DED. Type the name, title, and the date of the signature. Part II: FUNDING SUMMARY Using the activity code number and description provided on the Funding Summary, enter the dollar amount budgeted by funding source for each activity to be undertaken. Round amounts to the nearest hundred dollars. Identify the sources of matching or other funds. Be certain that the figures are correctly added and are the same as provided in Box 5 of Part I.



APPLICATION FOR ECONOMIC DEVELOPMENT CATEGORY COMMUNITY DEVELOPMENT BLOCK GRANT (CDBG) Nebraska Department of Economic Development (DED) PPAARRTT II.. GGEENNEERRAALL IINNFFOORRMMAATTIIOONN TYPE OR PRINT ALL INFORMATION

1. APPLICANT IDENTIFICATION Applicant Name: Address: City: State: NE Zip: Local Government Contact: Phone: Fax: Email: Federal Tax ID Number: Duns # (Local Government):

2. APPLICATION PREPARER INFORMATION Name: Address: City: State: Zip: Phone: Email: Federal Tax ID #/SSN#: Application Preparer (check one)

Local Staff Out-of-State Consultant

In-State Consultant Non-Profit Organization

Economic Development District DED Staff

3. DEVELOPMENT CATEGORY Direct Loan Job Training Spec Building/Park Public Works/Infrastructure Entrepreneuer Development

5. FUNDING SOURCES CDBG Funds Requested: $ Matching Funds: $ Other Funds: $ Total Project Funds: $ (round amounts to the nearst hundred dollars)

4. APPLICATION TYPE Individual Joint

6. PROGRAM SUMMARY: Brief narrative description of the project for which CDBG funds are requested: _______________________________________________________________________________________________ 7. CERTIFYING OFFICIAL: Chief elected officer of local government requesting CDBG funds To the best of my knowledge and belief, data and information in this application are true and correct, including any commitment of local or other resources. This application has been duly authorized by the governing body of the applicant following an official public hearing. This applicant will comply with all Federal and state requirements governing the use of CDBG funds.

Signature in ink Typed Name and Title Date Signed Attest Typed Name and Title Date Signed

SUBMIT THE ORIGINAL OF THE ENTIRE APPLICATION (no additional copies are required) TO: Nebraska Department of Economic Development Housing and Community Development Division PO Box 94666 - 301 Centennial Mall South Lincoln, NE 68509-4666 (800) 426-6505 Fax (402) 471-3778

DED USE ONLY Application Number

-ED- Date Received



PPAARRTT IIII.. FFUUNNDDIINNGG SSUUMMMMAARRYY (Round amounts to the nearest hundred dollars.)

Activity Code

CDBG Funds

Matching Funds

Other Funds

Total Funds

Sources of Matching or Other Funds

0010 Acquisition

0020 Planning1

0070 Public Fac. & Improvements

0230 Streets

0250 Storm Sewers

0270 Sanitary Sewers

0290 Sewage Treatment

0310 Water Source/Well

0330 Water Distribution

0350 Water Storage

0370 Flood & Drainage Facilities

0600 ED Infrastructure Development

0690 Fixed Assets / Land and Building

0691 Speculative Building / Park

0700 Direct Financial Assistance to For-Profit Business

0710 Job Training

0730 Working Capital

0750 Fixed Assets / Machinery & Equipment

0770 Fixed Assets / Leaseholds Improvements

0181 General Administration

1000 TOTAL PROGRAM COSTS

1 Only allowable as an Activity when associated with a Speculative Park/Data Center project.



Exhibit A Participation Identification and Project Summary

1. Name of Business

Address

(City) NE (Zip) Telephone No. ( )

Fax No. ( )

Contact Person:

DUNS Number (Business)

Email address:

3. Business Type Start-Up Existing Business Buy-Out Spec Building / Park

2. Business Organization Proprietorship Partnership Corporation Other 4. Business Classification Administrative Technology Management Headquarters Tourism Manufacturing Transportation Retail Service Warehouse/Distribution

5. Project Location: Within the City Limits of (Name of City)

Outside the City Limits, but within the Zoning Jurisdiction of (Name and City)

Outside the Zoning Jurisdiction of (Name of City) in (County)

Located in county (not in incorporated areas.)

Zoning Action Required? Yes No Project in 100 yr. floodplain? Yes No

If zoning action is required, please attach an explanation.

Attach a legal description of the project’s location.

Attach a map of the applicant’s jurisdiction, identifying the areas in which the project activity will occur.

6. Ownership Identification

A. Name %

B. Percentage of Company Owned by: Women __________%

Minorities %

Disabled Persons %

7. Affiliated Businesses

A. Does the Company have a Parent or Subsidiary? Yes No If Yes, Identify Name:

Address:

City: State: Zip:

B. Do the Owners of the Company have an Ownership interest in any Other Company? Yes No If Yes to Either A or B Identify Below: Company Name Relationship % Owned



8. Project Participation Identification: Identify All Entities Participating with the Financing of the Project.

A. Financial Institution(s)

Name:

Address:

(City) (State) (Zip)

Contact Person:

Title: Email address:

Telephone: ( )

B. Other Local, State or Federal Financing Sources

Agency Name:

Address:


Contact Person:


Telephone: ( )

C. Source(s) of Equity/Investment Capital

Name:

Address:


Telephone: ( )


Name:

Address:


Telephone: ( )


Name:

Address:


Contact Person:


Telephone: ( )

Agency Name:

Address:


Contact Person:


Telephone: ( )

Name:

Address:


Telephone: ( )


Name:

Address:


Telephone: ( )




Exhibit B

PROJECT FINANCING AND USE OF LOAN PROCEEDS

I. Project Financing

Amount

Percent Project

Cost

Annual

Debt Service

Maturity

Interest

Rate

Lien

Position

1. CDBG Share of

Project Cost

$

$

2. Private Sector

Financial Institution

$

$

Other (Identify)

$

$

Total Private Sector Financing

$

$

3. Other Federal Sources

$

$

4. Equity Injection

$

$

5. TOTAL PROJECT

FINANCING

$

$



Exhibit C

Job Creation / Retention Information 1. Total full time equivalent positions as of (date)

2. Total new full time equivalent positions being created from the project which will be filled for one year or longer. _________________ 3. The total number of retained FTEs that will result from the project for which notification of lay-off or termination has occurred, or is apt to occur (provide explanation) if the project is not carried out. Classify retained FTEs as follows: _________________

a. Total jobs known to be currently held by LMI people. For each employee, submit the Employee Certification Form or ________

b. Total number of jobs that can reasonably be expected to become available through

turnover to LMI persons within a two year period from an award of CDBG funds. The number of jobs should be based upon the historical turnover rate for each of the past two years converted to FTE positions. ________

4. (For seasonal hiring only). Total new full time equivalent positions being created

from the project which will be filled for 3 months or longer. 5. Provide a job description for each new position. Complete all information for each job

title and identify the number of positions to be created. (Use the attached list for job titles)

6. Describe training and recruitment opportunities that would make the retained jobs available to LMI persons. All CDBG funded projects may use Nebraska Workforce Development for their recruiting of new employees to assist in the documentation of first consideration being given to low and moderate income persons. Nebraska Workforce Development will obtain and keep on file for verification the necessary information about the person to determine low and moderate income status. The distance from residence and availability of transportation to the employment site should also be considered in determining whether a particular low and moderate income person can seriously be considered an applicant for the job.

7. Complete the projected hiring schedule for positions expected to become available through turnover. Job Descriptions

No. of FTE Positions to be

Created / Retained

Job Title

Skills (describe)

Education (indicate HS

education, specialized training, 4-yr degree, other)

Experience (No. of yrs)

Wage / Salary

Benefit Package

Created

Retained

Business Signature – Authorized Person Date Typed Name and Title



Exhibit C (continued)

Nebraska Department of Economic Development TITLES FOR JOB CREATION/RETENTION

Economic Development Application

For each job retained or created, the following general titles are to be used. These titles are provided by the Economic Development Administration (EDA) Job Category Definitions. 1. Officials and Managers - Occupants requiring administrative personnel who set broad policies, exercise overall

responsibility of execution of these policies, and individual departments or special phases of a firm’s operations. This includes: Officials, Executives, middle management, plant managers and superintendents, salaried supervisors who are members of management, purchasing agents and buyers, and kindred workers.

2. Professionals - Occupants requiring either college graduation or experience of such kind and amount as to provide a comparable background includes: accountants and auditors, airplane pilots and navigators, architects, artists chemists, designers, dietitians, editors, engineers, lawyers, librarians, mathematicians, natural scientists, registered professional nurses, professional and labor relations workers, physical scientists, physicians, social scientists, teachers, and kindred workers.

3. Technicians - Occupants requiring a combination of basic scientific knowledge and manual skill which can be obtained through about 2 years of post-high school education such as is offered in many technical institutions and junior colleges, or through equivalent on the job training. This includes: computer programmers and operators, drafters, engineering aides, junior engineers, mathematic aides, licensed practical or vocational nurses, photographers, radio operators, scientific assistants, surveyors, technical illustrators, technicians (medical, dental, electronic, physical science) and kindred workers.

4. Sales - Occupants engaging wholly or primarily in direct selling. This includes: advertising agenda and sales workers; insurance agents and brokers; real estate agents and brokers; sales workers; demonstrators and retail sales workers; and sales clerks, grocery clerks and cashiers; and kindred workers.

5. Office and Clerical - Includes all clerical-type work regardless of level of difficulty, where the activities are predominantly non-manual though some manual work not directly involved with altering or transporting the products is included. This includes: bookkeepers, cashiers, collectors (bills and accounts), messengers and office helpers, office machine operators, shipping and receiving clerks, stenographers, typists, and secretaries, telegraph and telephone operators, and kindred workers.

6. Crafts Workers (skilled) - Manual workers of relatively high level having a thorough and comprehensive knowledge of the processes involved in their work. Exercise considerable independent judgment and usually receive an extensive period of training. This includes: the building trades, hourly paid supervisors and lead operators (who are not members of management), mechanic and repairers, skilled machining occupations, compositors and typesetters, electricians, engravers, job setters (metal), motion picture projectionists, pattern and model makers, stationary engineers, tailors, and kindred workers.

7. Operatives (semi-skilled) - Workers who operate machines or other equipment or perform other factory-type duties of intermediate skill level which can be mastered in a few weeks and require only limited training. This includes: apprentices (auto mechanics, plumbers, electricians, machinists, mechanics, building trades, metal working trades, printing trades, etc.), operatives, attendants (auto service and parking), blasters, chauffeurs, delivery workers, dress makers and sewers (except factory), dryer’s furnaces workers, heaters (metal), laundry and dry cleaning, operatives, milliners, mine operatives and laborers, motor operators, oilers and greasers (except auto), painters (except construction and maintenance), photographic process workers, boiler tenders, truck and tractor drivers, weavers (textile), welders and flame metals workers, and kindred workers.

8. Laborers - Workers in manual occupations which generally require no special training perform elementary duties that may be learned in a few days and require the application of little or no independent judgment. This includes: garage laborers; car washers and greasers; gardeners (except farm) and ground keepers; stevedores; wood choppers; laborers performing lifting, digging, mixing loading, and pulling operations; and kindred workers.

9. Service Workers - Workers in both protective and non-protective service occupations. This includes attendants (hospital and

other institutions, professional and personal service, including nurse’s aides and orderlies), barbers, chairworkers and cleaners, cooks (except household), counter and fountain workers, elevator operators, firefighters and fire protection guards, door keepers, stewards, janitors, police officers and detectives, porters, waiters and waitresses, and kindred workers.



EXHIBIT D APPLICANT’S STATEMENT OF ASSURANCES AND CERTIFICATIONS

The (Name of the Local Government Unit) (Applicant) hereby assures and certifies to the Nebraska Department of Economic Development regarding an application for Community Development Block Grant (CDBG) funds, the following: THRESHOLD CERTIFICATIONS 1. There are no significant unresolved audit findings relating to any prior grant award from the federal and/or state government

that would adversely affect the administration of this grant. 2. No legal actions are underway or being contemplated that would significantly impact the Applicant’s capacity to effectively

administer the program, and to fulfill the CDBG program; and 3. No project costs have been incurred that have not been approved in writing by the Department. FEDERAL COMPLIANCE CERTIFICATIONS 4. It will adopt and follow a residential anti-displacement and relocation assistance plan that will minimize displacement as a

result of activities assisted with CDBG funds. 5. It will conduct and administer its programs in conformance with:

a. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), and the regulations issued pursuant thereto (24 CFR Part 1). b. Title VIII of the Civil Rights Act of 1968 (Pub. L. 90-284), as amended, administering all programs and activities relating to

housing and community development in a manner to affirmatively further fair housing, and will take action to affirmatively further fair housing in the sale or rental of housing, the financing of housing and the provision of brokerage services.

c. The Fair Housing Act of 1988 (42 USC 3601-20) and will affirmatively further fair housing.

6. It will not attempt to recover any capital costs of public improvements assisted in whole or part by assessing any amount

against properties owned and occupied by persons of low- and moderate-income, including any fee charged or assessment made as a condition of obtaining access to such public improvements, unless (1) grant funds are used to pay the proportion of such fee or assessment that relates to the capital costs of such public improvements that are financed from revenue sources other than grant funds, or (2) for purposes of assessing any amount against properties owned and occupied by persons of LMI who are not persons of very-low income, the recipient certifies to the state that it lacks sufficient grant funds to comply with the requirements of clause (1).

7. It will comply with all provisions of Title I of the Housing and Community Development Act of 1974, as amended, which have

not been cited previously as well as with other applicable laws. CITIZEN PARTICIPATION PLAN CERTIFICATION 8. It certifies that a detailed citizen participation plan is on file which includes:

a. Providing and encouraging citizen participation with particular emphasis on participation by lower income persons who are residents of slum and blight areas in which funds are proposed to be used to include target areas as identified in the application.

b. Providing citizens with reasonable and timely access to local meetings, information, and records relating to the Applicant's

proposed and actual use of CDBG funds. c. Furnishing citizens with information, including but not limited to, the amount of CDBG funds expected to be made

available for the current fiscal year, including CDBG funds and anticipated program income; the range of activities that may be undertaken with CDBG funds; the estimated amount of CDBG funds to be used for activities that will meet national objective of benefit to low- and moderate-income people, and the proposed CDBG activities likely to result in displacement and the grantee's anti-displacement and relocation plans.

d. Providing technical assistance to groups representative of persons of low and moderate income that request such

assistance in developing proposals. The level and type of assistance is to be identified within the plan. e. Providing for public hearings at different stages of the program, for the purpose of obtaining citizen's views and

responding to proposals and questions. The hearings must cover community development and housing needs, development of proposed activities and review of program performance. The hearing to cover community development needs must be held before submission of an application to the state. The hearing on program performance must be held during the implementation of the CDBG awarded grant. There must be reasonable notice of the hearings and they must be held at times and locations convenient to potential or actual beneficiaries, with accommodations for the handicapped. Public hearings are to be conducted in a manner to meet the needs of non-English speaking residents where a significant number of non-English speaking residents can be expected to participate.

EXHIBIT D



f. Providing citizens with reasonable advance notice of, and opportunity to comment on, proposed activities in the application to the state and for grants already made, activities that are added to, deleted or substantially changed from the application to the state. Substantially changed is defined in terms of purpose, scope, location or beneficiaries defined by the state established criteria.

g. Providing citizens the address, phone number and acceptable hours for submitting complaints and grievances and

providing timely written responses to written complaints and grievances within 15 working days where practicable.

SPECIAL REQUIREMENTS AND ASSURANCES. 9. The Applicant will comply with the administrative requirements of the program, those applicable items in the 1995

Consolidated Plan, Title I of the Housing and Community Development Act of 1974, Public Law 93-383, as amended, and 24 CFR Part 570 (including parts not specifically cited below), and the following laws, regulations and requirements, both federal and state, as the pertain to the design, implementation and administration of the local project, if approved:

CIVIL RIGHTS AND EQUAL OPPORTUNITY PROVISIONS ! Public Law 88-352, Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000(d), et. seq.) (24 CFR Part 1) ! Section 109 of the Housing and Community Development Act of 1974, As Amended ! Age-Discrimination Act of 1975, As Amended (42 U.S.C. 6101, et. seq.) ! Section 504 of the Rehabilitation Act of 1973, As Amended (29 U.S.C. 794) and the Americans with Disability Act ! Executive Order 11246, As Amended ! Executive Order 11063, As Amended by Executive Order 12259 (24 CFR Part 107)

ENVIRONMENTAL STANDARDS AND PROVISIONS ! Section 104(f) of the Housing and Community Development Act of 1974, As Amended ! Title IV of the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. 4831) and the Implementing Regulations found

at 24 CFR Part 35 ! The National Environmental Policy Act of 1969 (42 U.S.C. Section 4321, et. seq., and 24 CFR Part 58) ! The Clean Air Act, As Amended (42 U.S.C. 7401, et. seq.) ! Farmland Protection Policy Act of 1981, (U.S.C. 4201, et. seq.) ! The Endangered Species Act of 1973, As Amended (16 U.S.C. 1531, et. seq.) ! The Reservoir Salvage Act of 1960 (16 U.S.C. 469, et. seq.), Section 3 (16 U.S.C. 469 a-1), As Amended by the

Archaeological and Historic Preservation Act of 1974 ! The Safe Drinking Water Act of 1974 [42 U.S.C. Section 201, 300(f), et. seq., and U.S.C. Section 349 as Amended,

particularly Section 1424(e) (42 U.S.C. Section 300H-303(e)] ! The Federal Water Pollution Control Act of 1972, As Amended, including the Clean Water Act of 1977, Public Law

92-212 (33 U.S.C. Section 1251, et. seq.) ! The Solid Waste Disposal Act, As Amended by the Resource Conservation and Recovery Act of 1976 (42 U.S.C.

Section 6901, et. seq.) ! The Fish and Wildlife Coordination Act of 1958, As Amended, (16 U.S.C. Section 661, et. seq.) ! EPA List of Violating Facilities ! HUD Environmental Standards (24 CFR, Part 51, Environmental Criteria and Standards and 44 F.R. 40860-40866,

July 12, 1979) ! The Wild and Scenic Rivers Act of 1968, As Amended (16 U.S.C. 1271, et. seq.) ! Flood Insurance ! Executive Order 11988, May 24, 1978: Floodplain Management (42 F.R. 26951, et. seq.) ! Executive Order 11990, May 24, 1977: Protection of Wetlands (42 F.R. 26961, et. seq.) ! Environmental Protection Act, NEB. REV. STAT. 81-1501 to 81-1532 (R.R.S. 1943) ! Historic Preservation

LABOR STANDARDS AND PROVISIONS

! Section 110 of the Housing and Community Development Act of 1974, As Amended ! Fair Labor Standards Act of 1938, As Amended, (29 U.S.C. 102, et. seq.) ! Davis-Bacon Act, As Amended (40 U.S.C. 276-a - 276a-5); and Section 2; of the June 13, 1934 Act., As Amended

(48 Stat. 948.40 U.S.C. 276(c), popularly known as The Copeland Act ! Contract Work Hours and Safety Standards Act (40 U.S.C. 327, et. seq.) ! Section 3 of the Housing and Urban Development Act of 1968 [12 U.S.C. 1701(u)]

EXHIBIT D



FAIR HOUSING STANDARDS AND PROVISIONS * Section 104(a)(2) of the Housing and Community Development Act of 1974, As AmendedPublic Law 90-284, Title VIII of

the Civil Rights Act of 1968 (42 U.S.C. 3601, et. seq.). As Amended by the Fair Housing Amendments Act of 1988 * Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970, As Amended (42 U.S.C. 4630) and the

Implementing Regulations Found at 49 CFR Part 24 * Relocation Assistance Act, NEB. REV. STAT. 76-1214 to 76-1242 (R.S. Supp. 1989) * Nebraska Civil Rights Act of 1969 20-105 to 20-125, 48-1102 and 48-1116 Uniform Procedures for Acquiring Private Property for Public Use, NEB. REV. STAT. 25-2501 to 25-2506 (R.R.S. 1943)

ADMINISTRATIVE AND FINANCIAL PROVISIONS * 78 FR 78589 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards “Cost

Principles” * 78 FR 78589 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards

“Administrative Requirements” * 24 CFR 570.503 - Grant Administration Requirements for Use of Escrow Accounts for Property Rehabilitation Loans and

Grants * 24 CFR 570.488 to 570.499a - States Program: State Administration of CDBG Nonentitlement Funds * Community Development Law, NEB. REV. STAT. 18-2101 to 18-2144 (R.S. Supp. 1982) * Public Meetings Law, NEB. REV. STAT. 18-1401 to 18-1407 (R.R.S. 1943) * 24 CFR Subtitle A (4-1-98 Edition) – 85 Administrative requirements for grants and cooperative agreements to State, local

and federally recognized Indian tribal governments MISCELLANEOUS.

* Hatch Act of 1938, As Amended (5 U.S.C. 1501, et. seq.) The Applicant hereby certifies that it will comply with the above stated assurances. Signed _____________________________________

Subscribed in my presence and sworn to before me.

Title

Date Notary Public (Not required if on letterhead) February 2015 Revised



EXHIBIT E (Sample) updated January 2014 Citizen Participation Plan

(unit of local government), Nebraska A. Participation by Citizens

All citizens, including low- and moderate-income citizens, shall be requested and encouraged to participate in the assessment of community issues, problems and needs; the identification of potential solutions; and priority to such issues, problems and needs, as follows: 1. All citizens shall be periodically requested to complete a community needs survey to identify community and neighborhood

issues, problems and needs. 2. All citizens shall be notified by publication and posting of all meetings to discuss the identified needs, potential solutions

and solution priorities. 3. All citizens, particularly low and moderate-income citizens, shall be afforded the opportunity to serve on various community

improvement task forces established by the (local government name). B. Access to Meetings, Information and Records

Notice of public meetings conducted by the (local government name).shall be published or posted within a reasonable number of days prior to such meetings. Agendas of all such meetings shall be available at the (location) for public inspection. All meetings where CDBG projects or applications are to be discussed shall be published or posted (within a reasonable number of) days prior to such meetings and all information and records concerning such CDBG projects or applications shall be available for public inspection at the (location). All meetings will be held at a time and (location) convenient to potential or actual beneficiaries which will be accessible to all citizens. The building and site will also be accessible to persons with disabilities.

C. Specific CDBG Project Information All citizens shall be provided with information regarding specific CDBG projects through public meetings and publication of notices which provide all pertinent information regarding any CDBG project including, but not limited to: 1. The amount of CDBG funds expected to be made available to the (local government name).for the current fiscal year,

including CDBG funds and anticipated program income; 2. The specific range of activities that may be undertaken with CDBG funds; 3. The estimated amount of CDBG funds to be used for activities that will meet the national objective of benefit to low-and

moderate-income persons, and; 4. A description of any proposed CDBG funded activities that are likely to result in displacement of persons along with the

(local government name).anti-displacement and relocation plans. D. Provisions for Technical Assistance to Citizens

The (local representative) shall maintain current information of available resources for community improvement efforts and CDBG programs available and provide such information upon request by any citizen or group representing any citizen or group of citizens and the (local representative) shall provide assistance in developing proposals to address issues, problems and needs identified by such citizen or citizens.

E. Public Hearing on CDBG Activities

The (local unit of government) shall enact a minimum of two (2) public meetings or hearings to be conducted with regard to any CDBG application. At least one meeting or hearing shall be conducted prior to the submission of any such application and a second public hearing shall be held near the completion of any CDBG funded activity to obtain citizen input, comments or opinions with regard to such application(s) and to program or project performance. The (local representative) shall act as the contact person for all questions, comments or concerns expressed by any citizen with regard to any CDBG program or project and shall forward any such questions, comments or concerns to the (local unit of government) at the next regular meeting of the (local government name) immediately following expression of such questions, comments or concerns. The (local representative) shall also be responsible for transmitting the (local government name).response to any such question, comment or concerns to the citizen or citizens expressing the same.

F. Needs of Non-English Speaking Citizens

The (local unit of government) shall conduct the public hearings in a manner to meet the needs of non-English speaking residents where a significant number of non-English speaking residents can reasonably be expected to participate, the (local representative) shall arrange for oral or written translation of information regarding any CDBG program, application or project upon request by such non-English speaking persons or representatives of such persons.



G. Compliance/Grievance Procedures The (local representative) shall post a notice at the (location) that provides name, telephone number, address and office hours of the (local government name).) for citizens who wish to file a complaint or grievance regarding any CDBG program, project or application. Individuals wishing to submit a complaint or file a grievance concerning activities, of or application for, CDBG funds may submit a written complaint or grievance to the (local representative). The (local representative) shall present such complaint or grievance to the (location) at the next regular meeting of the (local government name), where it be reviewed by the Board members. The individual submitting such complaint or grievance shall be notified of such meeting and shall be given the opportunity to make further comments at such meeting. The (local government name).shall issue a written response to any complaint or grievance within fifteen (15) days following the meeting at which a response is formulated. Such response shall be mailed to the individual citizen(s) submitting the complaint or grievance by the (local representative) to the last known address of said citizen(s). In the event that the nature of the complaint or grievance is determined to be a matter requiring immediate action, a special meeting of the (local government name).shall be called to review the matter within ten (10) days of receipt of such complaint or grievance.

H. Adoption

This Citizen Participation Plan is hereby adopted by action of the (elected body by local government name), Nebraska.

(Name of Chief Elected Official), (Title)

Attest: (Name of local representative), (Title)

Date

Exhibit E (continued)

[sample form]



Exhibit F

NOTICE OF PUBLIC HEARING ON APPLICATION FOR COMMUNITY DEVELOPMENT BLOCK GRANT PROGRAM GRANT

Notice is hereby given that on [date/time] at [location details] the [name of the governing board/council/other] of the [name of the applicant unit of general local government] will hold a public hearing concerning an application to the Nebraska Department of Economic Development for a grant under the Community Development Block Grant ("CDBG") program. The grant application will be available for public inspection at [place]. Such grants are available to local governments for economic development activities in the local community. The [name of applicant unit of general local government] is requesting [$ amount of CDBG funds being requested from DED] for [description of project including name of benefited business; all project activities to be undertaken and the amount of funds associated with each activity]. All the CDBG funds will be used for activities that will meet the CDBG national objective of benefiting low-to-moderate income persons. The CDBG funded activities are unlikely to result in the residential displacement of people, and should such displacement occur it will be minimized and resolved pursuant to the [name of applicant governmental unit]'s antidisplacement and relocation plans. All interested parties are invited to attend this public hearing at which time you will have the opportunity to be heard regarding the grant application. Written and oral testimony will also be accepted at the public hearing. Written comments addressed to [name of specific contact person with the applicant unit of general local government] at [address] will be accepted as part of the record of the hearing if received on or before the scheduled date of the hearing. Individuals requiring physical or sensory accommodations including interpreter service, Braille, large print, or recorded materials, please contact (contact person) at (address, phone number) no later than (date). Accommodations will be made for persons with disabilities and non-English speaking individuals provided that (number) day notice is received by the (Name of the Local Government Unit). Dated at [location] on [date], by the [name of the governing board/council/other] of the [name of the applicant unit of general local government].

NOTE: This boxed area is informational, not part of the required form of the notice. This language must be used for the official public hearings. Language in [ ] requires insertion of appropriate wording and is not designed to be in the notice verbatim. At this hearing, specific CDBG program requirements and related project issues should be reviewed. For example, if taxes or user charges will need to be increased as part of financing the project, it is especially important that residents understand the necessity of raising funds. This discussion should specifically be reflected in meeting minutes. The Department requires the following documentation: (1) submission of evidence of proof of publication (or certification of posting); (2) submission of the meeting minutes; and, (3) submission of a summary of citizens' comments.



EXHIBIT G RESOLUTION AUTHORIZING CHIEF ELECTED OFFICIAL TO SIGN AN

APPLICATION FOR CDBG FUNDS --Sample Format--

Whereas, the (Name of the Local Government Unit), Nebraska, is an eligible unit of a general local government authorized to file an application under the Housing and Community Development Act of 1974 as amended for Small Cities Community Development Block Grant Program, and, Whereas, the (Name of the Local Government Unit), Nebraska, has obtained its citizens’ comments on community development and housing needs; and has conducted public hearing(s) upon the proposed application and received favorable public comment respecting the application which for an amount of (amount of money) for (description of the project); and, NOW, THEREFORE, BE IT RESOLVED BY (Controlling Governmental Body) of (Name of the Local Government Unit), that the (Title of Chief Elected Official) be authorized and directed to proceed with the formulation of any and all contracts, documents or other memoranda between (Name of the Local Government Unit) and the Nebraska Department of Economic Development so as to effect acceptance of the grant application. Signed Title Date

NOTE: This boxed area is informational, not part of the required form of the notice. This language is to be

used for the official resolution. Language in ( ) requires insertion of appropriate wording and is not designed to be in the resolution verbatim.

Provide an original signature (on official letterhead) or a certified copy of the authorizing resolution.



EXHIBIT H FFATA REPORTING FORM/CERTIFICATION – CDBG & CDBG HOUSING

The Federal Funding Accountability and Transparency Act (FFATA) seeks to provide the public with greater access to Federal spending information. Due to FFATA requirements, units of general local government are required to provide the following information, which may be used by the Department of Economic Development (“Department”) to comply with federal reporting requirements. Please fill out the following form accurately and completely, have it signed by an authorized official, and submit to the Department along with your application for funding.

Name of Applicant: Applicant Address: City:

State:

Zip: -

Congressional District:

Applicant DUNS number: Principal Place of Performance of Proposed Project: City:

State:

Zip: -

Congressional District:

Brief Project Description:

If certain conditions are met, Applicant must provide names and total compensation of Applicant’s top five highly compensated Executives to the Department. Please answer question number 1, and follow the instructions. If directed to answer question 2, please answer question 2 and follow instructions. 1. In Applicant’s previous fiscal year, did Applicant receive (a) 80 percent or more of Applicant’s annual gross

revenues in U.S. federal contracts and subcontracts and other federal financial assistance subject to the Transparency Act, as defined in 2 C.F.R. 170.320; AND (b) $25,000,000 or more in annual gross revenues from contracts and subcontracts and other federal financial assistance subject to the Transparency Act, as defined in 2 C.F.R. 170.320?

Yes If yes, answer question 2 below. No If no, stop, you are not required to report names and compensation. Please sign and submit form to the Department. 2. Does the public have access to information about the compensation of Applicant’s senior executives through

periodic reports filed under section 13(a) or 15(d) of the Security Exchange Act of 1934 (15 U.S.C. 78(m)(a), 78o(d)), or section 6104 of the Internal Revenue Code of 1986?

Yes If yes, stop, you are not required to report names and compensation. Please sign and submit form to the Department. No If no, you are required to report names and compensation. Please fill out the remainder of this form.

Provide the names and Total Compensation of the top five most highly compensated Executives in the space below. (NOTE: Executive means officers, managing partners, or any other employees in management positions. Total Compensation means the cash and noncash dollar value earned by the Executive during the Applicant’s preceding fiscal year and includes salary and bonus, awards of stock, stock options, and stock appreciation rights; earnings for services under non-equity incentive plans, change in pension value, above market earnings on deferred compensation which is not tax-qualified; and other compensation exceeding $10,000 as defined in Appendix A to 2 C.F.R. Part 170.)

Name: Total Compensation:




Name: Total Compensation: The Applicant certifies that the information contained on this form is true and accurate. DED USE

Signed:

Title:

Date:



Exhibit J

SSTTAATTEE OOFF NNEEBBRRAASSKKAA COMMUNITY DEVELOPMENT BLOCK GRANT

PROGRAM INCOME CERTIFICATION Applicants are required to commit all available CDBG Local Program Income to a project, provided funds have not been committed to an already approved local project. The Department reserves the right to reduce additonal CDBG program funds based on the amount of local program income funds available. III. RLF Reconciliation 1) Beginning Balance (account balance

to date): $

2) Total Committed Funds Not Yet Disbursed (*see below) (-) $

3) Uncommitted Funds on Hand (=) $

* RLF Loans/Grants Committed but not yet disbursed Recipient Loan/Grant Description $ Amount Date of Commitment

Note: for each loan/grant committed but not yet disbursed, include supporting documentation, such as application approval or minutes from board meetings from the City or Village, showing approval of program income funds to be used for the project.

I certify that to the best of my knowledge and belief the information contained in this report is true and correct. _______________________________ ___________________________ ______________ Name/Title of Certifying Officer Signature Date



STATE OF NEBRASKA COMMUNITY DEVELOPMENT BLOCK GRANT

EMPLOYEE CERTIFICATION FORM

For use by ________________________________________________________________________________(Name of Employer) to meet the requirements of the Nebraska Department of Economic Development and U.S. Department of Housing and Urban Development (HUD). Dear Employee or Applicant: Please provide the information requested on this form by so that we can verify to the Nebraska Department of Economic Development that your employment here is achieving the goals of the Nebraska Community Development Block Grant Program. This information is voluntary. Your response should be based upon the earned family income in the county in which you reside. The information will be placed in you confidential personnel file and is available to only a limited number of company officials. The information is subject to verification by officials from {CITY, COUNTY, VILLAGE, NE} and representatives of the Nebraska Department of Economic Development. EMPLOYEE or APPLICANT: Please answer questions 1, 2 and 3: Find your family size and household income level. Count all family members including yourself living at home. HUD Income guidelines for {COUNTY, NE} ( See accompanying sheet for additional guidelines)

1 PERSON 2 PERSONS 3 PERSONS 4 PERSONS 5 PERSONS 6 PERSONS 7 PERSONS 8 PERSONS

Row A Row B Row C

1) My household size is _____ persons.

Please check the box below that represents your TOTAL household income FOR LAST YEAR in relation to the income levels in rows A, B, and C above. LAST YEAR my total income was:

LESS THAN THE AMOUNT IN ROW A BETWEEN THE AMOUNTS IN ROWS A AND B

BETWEEN THE AMOUNTS IN ROWS B AND C MORE THAN THE AMOUNT IN ROW C 2) Please Check the Box(es) that identify your race:

Single Race: Multi-Racial Identifiers: White American Indian/Alaskan Native and White Black/African American Asian and White Asian Black/African American and White American Indian/Alaskan Native American Indian/Alaskan Native and African/American Native Hawaiian/Other Pacific Islander Other Multi-Racial Other

3) Please answer these questions:

Do you consider yourself as being of Hispanic ethnicity? Yes No What sex are you? Female Male Do you have a disability that is a substantial handicap? Yes No Are you unemployed prior to taking this job? Yes No Are you a female head of household? Yes No

Your Name_______________________________________ Your Signature: ______________________________________ (Please print) Date Signed: ______________________________________ TO BE COMPLETED BY THE BUSINESS Indicate which job category is being considered for this person:

Officials or Managers Professional Technicians Sales Office or Clerical Craft Worker (skilled) Operatives (semi-skilled) Laborers (unskilled) Service Workers

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Economic Development Administration (EDA) Job Category Definitions

1. Officials or Managers - Occupants requiring administrative personnel who set broad policies, exercise overall responsibility of execution of these policies, and individual departments or special phases of a firm’s operations. This includes: Officials, Executives, middle management, plant managers and superintendents, salaried supervisors who are members of management, purchasing agents and buyers, and kindred workers. 2. Professional - Occupants requiring either college graduation or experience of such kind and amount as to provide a comparable background includes: accountants and auditors, airplane pilots and navigators, architects, artists chemists, designers, dietitians, editors, engineers, lawyers, librarians, mathematicians, natural scientists, registered professional nurses, professional and labor relations workers, physical scientists, physicians, social scientists, teachers, and kindred workers. 3. Technicians - Occupants requiring a combination of basic scientific knowledge and manual skill which can be obtained through about 2 years of post-high school education such as is offered in many technical institutions and junior colleges, or through equivalent on the job training. This includes: computer programmers and operators, drafters, engineering aides, junior engineers, mathematic aides, licensed practical or vocational nurses, photographers, radio operators, scientific assistants, surveyors, technical illustrators, technicians (medical, dental, electronic, physical science) and kindred workers. 4. Sales - Occupants engaging wholly or primarily in direct selling. This includes: advertising agenda and sales workers; insurance agents and brokers; real estate agents and brokers; sales workers; demonstrators and retail sales workers; and sales clerks, grocery clerks and cashiers; and kindred workers. 5. Office or Clerical - Includes all clerical-type work regardless of level of difficulty, where the activities are predominantly non-manual though some manual work not directly involved with altering or transporting the products is included. This includes: bookkeepers, cashiers, collectors (bills and accounts), messengers and office helpers, office machine operators, shipping and receiving clerks, stenographers, typists, and secretaries, telegraph and telephone operators, and kindred workers. 6. Craft Worker (skilled) - Manual workers of relatively high level having a thorough and comprehensive knowledge of the processes involved in their work. Exercise considerable independent judgment and usually receive an extensive period of training. This includes: the building trades, hourly paid supervisors and lead operators (who are not members of management), mechanic and repairers, skilled machining occupations, compositors and typesetters, electricians, engravers, job setters (metal), motion picture projectionists, pattern and model makers, stationary engineers, tailors, and kindred workers. 7. Operatives (semi-skilled) - Workers who operate machines or other equipment or perform other factory-type duties of intermediate skill level which can be mastered in a few weeks and require only limited training. This includes: apprentices (auto mechanics, plumbers, electricians, machinists, mechanics, building trades, metal working trades, printing trades, etc.), operatives, attendants (auto service and parking), blasters, chauffeurs, delivery workers, dress makers and sewers (except factory), dryer’s furnaces workers, heaters (metal), laundry and dry cleaning, operatives, milliners, mine operatives and laborers, motor operators, oilers and greasers (except auto), painters (except construction and maintenance), photographic process workers, boiler tenders, truck and tractor drivers, weavers (textile), welders and flame metals workers, and kindred workers. 8. Laborers (unskilled) - Workers in manual occupations which generally require no special training perform elementary duties that may be learned in a few days and require the application of little or no independent judgment. This includes: garage laborers; car washers and greasers; gardeners (except farm) and ground keepers; stevedores; wood choppers; laborers performing lifting, digging, mixing loading, and pulling operations; and kindred workers. 9. Service Workers - Workers in both protective and non-protective service occupations. This includes attendants (hospital and other institutions, professional and personal service, including nurses aides and orderlies), barbers, chairworkers and cleaners, cooks (except household), counter and fountain workers, elevator operators, firefighters and fire protection guards, door keepers, stewards, janitors, police officers and detectives, porters, waiters and waitresses, and kindred workers.



HUD INCOME GUIDELINES

{COUNTY, NE}

1 PERSON 2 PERSONS 3 PERSONS 4 PERSONS 5 PERSONS 6 PERSONS 7 PERSONS 8 PERSONS Row A Row B Row C

{COUNTY, NE}


{COUNTY, NE}


{COUNTY, NE}


{COUNTY, NE}


Date signed:___________________________________

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